title: SLEDAI-2K Does Not Conceal Worsening in a Particular System When There Is Overall Improvement.
abstract: OBJECTIVE
  To determine whether the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) is valid in identifying patients who had a clinically important overall improvement with no worsening in other descriptors/systems.
  
  
  METHODS
  Consecutive patients with systemic lupus erythematosus with active disease who attended the Lupus Clinic between 2000 and 2012 were studied. Based on the change in the total SLEDAI-2K scores on last visit, patients were grouped as improved, flared/worsened, and unchanged. Patients showing improvement were evaluated for the presence of new active descriptors at last visit compared with baseline visit.
  
  
  RESULTS
  Of the 158 patients studied, 109 patients had improved, 38 remained unchanged, and 11 flared/worsened at last visit. In the improved group, 11 patients had a new laboratory descriptor that was not present at baseline visit. In those 11 patients, this new laboratory descriptor was not clinically significant and did not require a change in disease management.
  
  
  CONCLUSIONS
  The SLEDAI-2K identifies improvement in disease activity overall without concealing clinically important worsening.
authors.affiliation: From the University of Toronto, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Research Institute, Toronto, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Assistant Professor of Medicine, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Co-director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto; J. Su, MB, BSc; D. Ibañez, MSc, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital.
authors.forename: Zahi
authors.initials: Z
authors.lastname: Touma
authors.affiliation: From the University of Toronto, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Research Institute, Toronto, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Assistant Professor of Medicine, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Co-director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto; J. Su, MB, BSc; D. Ibañez, MSc, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital.
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
authors.affiliation: From the University of Toronto, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Research Institute, Toronto, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Assistant Professor of Medicine, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Co-director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto; J. Su, MB, BSc; D. Ibañez, MSc, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital.
authors.forename: Jiandong
authors.initials: J
authors.lastname: Su
authors.affiliation: From the University of Toronto, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Research Institute, Toronto, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Assistant Professor of Medicine, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Co-director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto; J. Su, MB, BSc; D. Ibañez, MSc, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital.
authors.forename: Dominique
authors.initials: D
authors.lastname: Ibañez
authors.affiliation: From the University of Toronto, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Research Institute, Toronto, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Assistant Professor of Medicine, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Co-director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto; J. Su, MB, BSc; D. Ibañez, MSc, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital. m.urowitz@utoronto.ca.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Urowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D063189:Symptom Assessment; D055815:Young Adult
keywords: DISEASE ACTIVITY; SLEDAI-2K; SYSTEMIC LUPUS ERYTHEMATOSUS