title: The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index in patients with systemic lupus erythematosus.
abstract: OBJECTIVE
  To test the reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in the assessment of patients with SLE.
  
  
  METHODS
  Ten patients with SLE, representing a spectrum of damage and activity, were included. Each patient was examined by 6 of 10 physicians from 5 countries, representing 10 lupus clinics. The SLICC/ACR Damage Index was used to assess accumulated damage, and the SLEDAI was used to assess disease activity. The order of the patients and physicians was randomized according to a Youden square design.
  
  
  RESULTS
  The SLICC/ACR Damage Index detected differences among patients (P < 0.001). There was no detectable observer difference (P = 0.933), and there was no order effect (P = 0.261). Similar results were obtained with the SLEDAI. There was concordance in the SLICC/ACR Damage Index among observers, despite a wide spectrum of disease activity detected by the SLEDAI.
  
  
  CONCLUSIONS
  Physicians from different centers are able to assess patients with SLE in a reproducible way, using the SLEDAI to assess disease activity and the SLICC/ACR Damage Index to assess accumulated damage.
authors.affiliation: The Centre for Prognosis Studies in the Rheumatic Diseases, The Toronto Hospital, Ontario, Canada.
authors.forename: D D
authors.initials: DD
authors.lastname: Gladman
authors.forename: M B
authors.initials: MB
authors.lastname: Urowitz
authors.forename: C H
authors.initials: CH
authors.lastname: Goldsmith
authors.forename: P
authors.initials: P
authors.lastname: Fortin
authors.forename: E
authors.initials: E
authors.lastname: Ginzler
authors.forename: C
authors.initials: C
authors.lastname: Gordon
authors.forename: J G
authors.initials: JG
authors.lastname: Hanly
authors.forename: D A
authors.initials: DA
authors.lastname: Isenberg
authors.forename: K
authors.initials: K
authors.lastname: Kalunian
authors.forename: O
authors.initials: O
authors.lastname: Nived
authors.forename: M
authors.initials: M
authors.lastname: Petri
authors.forename: J
authors.initials: J
authors.lastname: Sanchez-Guerrero
authors.forename: M
authors.initials: M
authors.lastname: Snaith
authors.forename: G
authors.initials: G
authors.lastname: Sturfelt
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012720:Severity of Illness Index