SLEDAI Calculator
Systemic Lupus Erythematosus Disease Activity Index - Measure SLE disease activity
Clinical Manifestations
Check all present manifestations within the past 10 days:
CNS
Vascular
Renal
MSK
Cardiopulm
Derm
Immuno
Constitutional
Heme
Results
Severity Scale
Clinical Notes
- • Assess manifestations in past 10 days
- • Exclude alternative causes (infection, drugs)
- • Change ≥3 points = clinically meaningful
- • Use with physician global assessment
⚠️ Important
SLEDAI should be calculated by experienced clinicians. All findings must be attributed to SLE activity, not infection, medication, or other causes.
Understanding SLEDAI Score
The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) is a validated clinical index used to assess disease activity in patients with systemic lupus erythematosus (SLE). It consists of 24 weighted clinical and laboratory variables across 9 organ systems.
Scoring System
- 8 points: Major CNS manifestations (seizure, psychosis, organic brain syndrome, visual disturbance, cranial nerve disorder, lupus headache, CVA) and vasculitis
- 4 points: Renal manifestations (hematuria, proteinuria, pyuria, casts), arthritis, myositis, pleurisy, pericarditis
- 2 points: Rash, alopecia, mucosal ulcers, low complement, increased anti-DNA antibodies
- 1 point: Fever, thrombocytopenia, leukopenia
Clinical Application
SLEDAI is used to:
- Monitor disease activity over time
- Guide treatment decisions and intensification
- Assess response to therapy
- Predict disease flares and organ damage
- Stratify patients in clinical trials
Important Considerations
- All manifestations must be present within the past 10 days
- Findings must be attributable to SLE, not infection or medication
- CNS manifestations require exclusion of metabolic, infectious, or drug causes
- A change of ≥3 points is considered clinically meaningful
- SLEDAI-2K is a modified version that allows persistent activity to be scored
Limitations
While SLEDAI is widely used and validated, it has some limitations:
- Does not capture chronic damage (use SLICC/ACR Damage Index for this)
- May not reflect all aspects of disease severity
- Requires clinical expertise to differentiate SLE activity from other causes
- Some important manifestations may be underweighted
SLEDAI Manifestation Details
| Points | System | Manifestation | Definition |
|---|---|---|---|
| 8 | CNS | Seizure | Recent onset, exclude metabolic causes |
| 8 | CNS | Psychosis | Altered reality testing, exclude uremia/drugs |
| 8 | Vascular | Vasculitis | Ulceration, gangrene, tender nodules, infarction |
| 4 | Renal | Proteinuria | >0.5 g/24hr, new or increasing by ≥0.5g/24hr |
| 4 | Musculoskeletal | Arthritis | ≥2 joints with pain and signs of inflammation |
| 2 | Mucocutaneous | Rash | New or recurrent inflammatory rash |
| 2 | Immunologic | Low complement | Decreased C3, C4, or CH50 |
| 1 | Constitutional | Fever | >38°C, exclude infection |
Frequently Asked Questions
What is the difference between SLEDAI and SLEDAI-2K?
SLEDAI-2K is a modification of the original SLEDAI that allows persistent manifestations to be scored at subsequent visits, whereas the original SLEDAI only counted new or recurrent activity. SLEDAI-2K also includes more precise definitions for some manifestations and is now more commonly used in clinical practice and research.
How often should SLEDAI be assessed?
SLEDAI should be assessed at each clinic visit for patients with active SLE. For stable patients in remission, assessment every 3-6 months is typically sufficient. More frequent monitoring (monthly) may be needed during treatment changes or disease flares.
What SLEDAI score indicates a disease flare?
A flare is generally defined as an increase in SLEDAI score of ≥3 points. Mild-to-moderate flares typically show increases of 3-12 points, while severe flares show increases of >12 points. The specific manifestations causing the increase are also important in determining flare severity.
Can SLEDAI be used to measure organ damage?
No, SLEDAI measures reversible disease activity, not permanent organ damage. For assessing cumulative organ damage, use the SLICC/ACR Damage Index (SDI), which captures irreversible changes that have been present for at least 6 months. Both scores provide complementary information about SLE disease course.
What laboratory tests are needed to calculate SLEDAI?
To fully assess SLEDAI, you need: complete blood count (for leukopenia, thrombocytopenia), urinalysis (for hematuria, pyuria, casts, proteinuria), complement levels (C3, C4, CH50), anti-dsDNA antibodies, and basic metabolic panel. Additional tests may be needed based on clinical presentation (e.g., lumbar puncture for CNS symptoms).
How does SLEDAI guide treatment decisions?
SLEDAI helps guide therapy intensity: scores 0-5 may be managed with maintenance therapy; scores 6-10 often require treatment optimization or moderate immunosuppression; scores >10 typically need aggressive treatment with high-dose corticosteroids and/or immunosuppressants. The specific organ systems involved also influence treatment choices.
What is considered remission in SLE based on SLEDAI?
Clinical remission is generally defined as SLEDAI score of 0 (or ≤2 with only serologic activity) while on antimalarials only. Complete remission requires SLEDAI of 0 off all immunosuppressants (antimalarials allowed). Low disease activity state (LLDAS) allows SLEDAI ≤4 with no major organ activity, on low-dose prednisone (≤7.5 mg/day), and stable immunosuppressants.
Are there other disease activity measures for SLE?
Yes, other validated measures include BILAG (British Isles Lupus Assessment Group) index which provides more detailed organ-specific assessment, SLAM (Systemic Lupus Activity Measure), and physician global assessment (PGA). Many clinicians use SLEDAI in combination with PGA for comprehensive assessment. The choice of measure may depend on clinical setting and specific monitoring needs.