- Optionally enter patient demographics — name, age, sex, and date — to appear on the printed report.
- For the SLEDAI-2K / SELENA-SLEDAI tab: check each clinical or laboratory feature that is present AND attributable to active SLE in the past 10 days. Each item carries a weight (×1 to ×8) shown in parentheses. Rate the Physician Global Assessment (PGA) on the 0–3 scale.
- For the SLICC/ACR SDI tab: check each damage item that has been present for ≥6 months since diagnosis. Items must not be due to active inflammation. Some items allow scoring 0, 1, or 2 (e.g., multiple CVA events).
- Scores update live. Click Print / Save as PDF to generate a structured report for the medical record.
- Click Reset All to clear all checkboxes and scores.
All computation runs in your browser; no values are stored or transmitted.
When to Use
Use the SLEDAI-2K and SLICC/ACR Damage Index at every formal disease activity assessment visit in patients with confirmed systemic lupus erythematosus (SLE), especially those with lupus nephritis (ISN/RPS Class III, IV, or V). The SLEDAI-2K quantifies current disease activity; the SDI quantifies irreversible organ damage accrued since diagnosis. Together, they guide decisions about immunosuppression intensity, trial eligibility, and long-term prognosis.
Appropriate population
Adults with confirmed SLE (meeting ACR 1997 or SLICC 2012 classification criteria). SLEDAI-2K is used at baseline and at each clinic visit to track activity trends. SDI is typically calculated at 1 year post-diagnosis and annually thereafter, recording cumulative irreversible damage. Both tools are required for most clinical trial eligibility screening (BLISS-LN, AURORA, REGENCY, VOCANO trials).
Important limitations
SLEDAI-2K scores features as present or absent — it does not weight partial improvement, which is why change scores (delta-SLEDAI) must be tracked across visits rather than relying on any single value. The same 24 descriptors are shared between SLEDAI-2K and SELENA-SLEDAI; SELENA-SLEDAI adds the Physician Global Assessment (PGA, 0–3 VAS). SDI records only damage present for 6 or more months since diagnosis — do not score acute active lesions. Both tools require clinical and laboratory data from the current visit; retrospective scoring is unreliable.
Pearls & Pitfalls
Track the delta, not just the number
A SLEDAI-2K score of 6 in a patient whose previous score was 14 represents improvement; the same score rising from 2 signals escalating disease. The SELENA flare definition requires a SLEDAI increase of ≥3 AND a PGA increase of ≥1 — neither criterion alone is sufficient. Always compare to the prior visit value before changing therapy.
SDI ≥1 at one year is a major prognostic marker
Every increment in SDI is associated with an approximately 35% increase in mortality in multivariate analyses. Hydroxychloroquine (HCQ) is the single intervention most consistently shown to reduce SDI accrual over time — ensure every eligible patient is on HCQ (dose-adjusted for weight and renal function) unless truly contraindicated.
Pitfalls
(1) Do not score SDI items caused by active lupus — only irreversible damage present ≥6 months counts. Scoring active nephritis as renal damage will overestimate SDI and falsely indicate worse prognosis. (2) Proteinuria in the SLEDAI requires a new onset or increase of >0.5 g/24h — stable, pre-existing proteinuria does not score. (3) SLEDAI does not capture serositis adequately (pleuritis and pericarditis each score 2 regardless of severity) — do not use SLEDAI alone to decide whether to add steroids for severe pericarditis. (4) The SDI renal item for ESRD (dialysis or transplant) scores 3 points — ensure this is captured in all patients with CKD-5D regardless of SLE activity at that visit.
Why Use It
Lupus nephritis affects up to 60% of SLE patients in Southeast Asian populations — a prevalence substantially higher than in Western cohorts, likely driven by genetic factors and delayed diagnosis. Without structured scoring, disease activity is assessed subjectively, leading to under-treatment during flares and over-treatment during remission. SLEDAI-2K score of 6 or higher predicts renal flare and is used as an inclusion criterion for most biologic trials. SDI score of 1 or more at 5 years doubles mortality risk. Integrating both tools into routine practice aligns with the ACR 2024 and EULAR 2023 lupus nephritis guidelines, which explicitly recommend validated activity and damage instruments at every formal assessment.
SLEDAI-2K / SELENA-SLEDAI & SLICC/ACR Damage Index
Check each feature present in the past 10 days (SLEDAI) or since diagnosis (SDI). Use the tabs to switch between the two tools.
Check each feature present and attributable to active SLE in the past 10 days. Each item carries the weighted score shown in parentheses. The same 24 descriptors apply to both SLEDAI-2K and SELENA-SLEDAI.
Rate overall SLE disease activity on a 0–3 visual analogue scale. Required for SELENA-SLEDAI flare classification.
Record damage present for ≥6 months since diagnosis that is not due to active inflammation. Items score 0/1 unless noted (some allow 0/1/2).
About these tools
SLEDAI-2K (Gladman et al., J Rheumatol 2002) — Modified SLEDAI allowing persistent active disease to be scored, not just new-onset features. Score ≥6 = moderate-to-high activity.
SELENA-SLEDAI (Petri et al., Arthritis Rheum 2005) — Same 24 descriptors as SLEDAI-2K, plus the Physician Global Assessment (PGA, 0–3 VAS). Used in BLISS-LN, REGENCY, AURORA, and most biologics trials.
SLICC/ACR Damage Index (SDI) (Gladman et al., Arthritis Rheum 1996) — Records irreversible organ damage present for ≥6 months since diagnosis. SDI ≥1 predicts increased mortality. These calculators are educational aids — clinical judgement always takes precedence.
Next Steps
Use the result to support — not replace — clinical judgment.
- Interpret the value against the targets shown in the calculator and the Evidence section below, in the context of the full clinical picture.
- Trend serial measurements rather than acting on a single result; confirm abnormal or unexpected values before changing management.
- Apply the relevant KDIGO / specialty-guideline threshold and document the indication.
- Escalate or refer to nephrology when results are out of range, rapidly changing, or discordant with the clinical picture — and discuss the implications with the patient.
Evidence & References
Formula & Equations
SLEDAI-2K Score Interpretation
| SLEDAI-2K Score | Activity Level | Clinical Implication |
|---|---|---|
| 0 | Remission / Inactive | Target for maintenance therapy. Continue HCQ and lowest effective immunosuppression. |
| 1–5 | Mild Activity | Close monitoring; HCQ optimization; avoid over-treatment. Consider reducing steroids if stable. |
| 6–11 | Moderate Activity | Review induction or escalation of immunosuppression. Nephrology/rheumatology reassessment. |
| 12–19 | High Activity | Aggressive induction therapy indicated. Consider pulse steroids, MMF escalation, or biologics. |
| ≥20 | Very High Activity | Urgent multidisciplinary management. Hospitalization may be required. |
SLICC/ACR SDI Score Interpretation
| SDI Score | Damage Level | Clinical Implication |
|---|---|---|
| 0 | No Damage | Excellent outlook. Continue therapies that prevent accrual (HCQ, BP control, lipid management). |
| 1–2 | Mild Damage | Optimize therapy to prevent further accrual. Modifiable risk factor control is paramount. |
| 3–4 | Moderate Damage | SDI ≥1 predicts increased mortality. Aggressive control of CV, renal, and infectious risk factors. |
| ≥5 | Severe Damage | High mortality risk. Multidisciplinary approach and specialist review recommended. |
SLEDAI-2K Item Weights (24 descriptors)
| System | Items | Weight Each |
|---|---|---|
| Neuropsychiatric | Seizure, Psychosis, Organic brain syndrome, Visual disturbance, Cranial nerve disorder, Lupus headache, CVA, Vasculitis | ×8 |
| Musculoskeletal | Arthritis, Myositis | ×4 |
| Renal | Urinary casts, Hematuria, Proteinuria, Pyuria | ×4 |
| Skin, Mucosa, Serosae | New rash, Alopecia, Mucosal ulcers, Pleuritis, Pericarditis | ×2 |
| Immunologic | Low complement, Elevated anti-dsDNA | ×2 |
| Constitutional & Hematologic | Fever, Thrombocytopenia, Leukopenia | ×1 |
Evidence & References
The SLEDAI-2K was validated against its predecessor (SLEDAI 1992) by Gladman and colleagues at the University of Toronto, demonstrating equivalent sensitivity and better reliability for tracking persistent active disease. The SLICC/ACR Damage Index was developed through a multinational collaboration specifically to capture the irreversible end-organ consequences of SLE and its treatment. Both instruments are endorsed by the ACR 2024 and EULAR 2023 lupus nephritis guidelines and are required outcome measures in all major RCTs for biologics used in lupus nephritis.
- Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002;29(2):288–291.
- Gladman D, Ginzler E, Goldsmith C, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum. 1996;39(3):363–369.
- Petri M, Kim MY, Kalunian KC, et al. Combined oral contraceptives in women with systemic lupus erythematosus. N Engl J Med. 2005;353(24):2550–2558. [SELENA trial — SELENA-SLEDAI validation]
- Furie R, Rovin BH, Houssiau F, et al. Two-year, randomized, controlled trial of belimumab in lupus nephritis. N Engl J Med. 2020;383(12):1117–1128. [BLISS-LN — uses SELENA-SLEDAI as primary outcome]
