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Damage Index for Systemic Lupus Erythematosus

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System Lupus International Collaborating Clinics/ACR Damage Index for Systemic Lupus Erythematosus*

Item

Score

Ocular (either eye, by clinical assessment)

Any cataract ever

1

Retinal change or optic atrophy

1

Neuropsychiatric  

Cognitive impairment (e.g. memory deficit, difficulty with calculation, poor concentration, difficulty in spoken or written language, impaired performance levels) or major psychosis

1

Seizures requiring therapy for 6 months

1

Cerebrovascular accident ever (score 2 if > 1)

1 (2)

Cranial or peripheral neuropathy (excluding optic)

1

Transverse myelitis

1

Renal  

Estimated or measured glomerular filtration rate<50%

1

Proteinuria ≥3.5 gm/24hours

1

Or

End-stage renal disease (regardless of dialysis or transplantation)

3

Pulmonary  

Pulmonary hypertension (right ventricular prominence, or loud P2)

1

Pulmonary fibrosis (physical and radiograph)

1

Shrinking lung (radiograph)

1

Pleural fibrosis (radiograph)

1

Pulmonary infarction (radiograph)

1

Cardiovascular  

Angina or coronary artery bypass

1

Myocardial infarction ever (score 2 if > 1)

1 (2)

Cardiomyopathy (ventricular dysfunction)

1

Valvular disease (diastolic murmur, or systolic murmur >3/6)

1

Pericarditis for 6 months, or pericardiectomy

1

Peripheral vascular  

Claudication for 6 months

1

Minor tissue loss (pulp space)

1

Significant tissue loss ever (e.g. loss of digit or limb)(score 2 if > 1 site)

1 (2)

Venous thrombosis with swelling, ulceration, or venous stasis

1

Gastrointestinal  

Infarction or resection of bowel below duodenum spleen, liver, or gall bladder ever, for cause any (score 2 if > 1 site)

1 (2)

Mesenteric insufficiency

1

Chronic peritonitis

1

Stricture or upper gastrointestinal tract surgery ever

1

Musculoskeletal  

Muscle atrophy or weakness

1

Deforming or erosive arthritis (including reducible deformities, excluding avascular necrosis)

1

Osteoporosis with fracture or vertebral collapse (excluding avascular necrosis)

1

Avascular necrosis (score 2 if > 1)

1 (2)

Osteomyelitis

1

Skin  

Scarring chronic alopecia

1

Extensive scarring or panniculum other than scalp and pulp space

1

Skin ulceration (excluding thrombosis) for > 6 months

1

Premature gonadal failure

1

Diabetes (regardless of treatment)

1

Malignancy (exclude dysplasia) (score 2 if > 1 site)

1 (2)

* Damage (nonreversible change, not related to active inflammation) occurring since onset of lupus, ascertained by clinical assessment and present for at least 6 months unless otherwise stated. Repeat episodes must occurat least 6 months apart to score 2. The same lesion cannot be scored twice.