A 38-year-old woman with established SLE (on hydroxychloroquine) develops worsening arthritis, new oral ulcers, thrombocytopenia (platelets 68,000/µL), and serositis. Complement C3 and C4 are both low, and anti-dsDNA titre has risen 4-fold. The SELENA-SLEDAI score has increased by 8 points. Which scoring instrument would specifically classify this as a 'severe flare'?
- A BILAG-2004 index
- B PGA (Physician Global Assessment)
- C SELENA-SLEDAI Flare Index (SFI) ✓
- D SLICC Damage Index
Explanation
The SELENA-SLEDAI Flare Index (SFI) is specifically designed to classify SLE flares as mild/moderate or severe based on SLEDAI score changes, new medications needed, and physician global assessment. A severe flare by SFI criteria requires SLEDAI increase of ≥ 12, or physician global assessment of severe (≥ 2.5 on a 0–3 scale), or requires new cyclophosphamide/hospitalisation. BILAG-2004 is an organ-specific index that grades activity A–E per system and is used to identify which organ domains are active. The SLICC Damage Index measures irreversible damage, not disease activity. PGA alone does not classify flare severity systematically.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.