        
Scoring Items in BILAG
It is assumed that all items (symptoms and signs)
recorded in the BILAG Index are considered to
be due to active lupus, and that findings reflect disease activity during the 4
WEEK period prior to the current assessment visit. Features of active lupus
disease are scored according to the following scale:
0 = NOT PRESENT during the 4
WEEK period prior to the current assessment visit
1 = IMPROVING during the 4 WEEK
period prior to the current assessment visit
2 = SAME during the 4 WEEK
period prior to the current assessment visit
3 = WORSE during the 4 WEEK
period prior to the current assessment visit
4 = NEW in the 4 WEEK period
prior to the current assessment visit
All scores of 0-4 require entry since the default response on all questions
is Null.
0 =NOT PRESENT:
If an item is not present on clinical assessment, the
default score of Null must be
changed to 0 .
1 = IMPROVING:
Should be used to score a feature that was present for
some time during the 4 week period prior to the clinic visit but that has
resolved by the time of the visit, or that has been improving for at least the
two weeks prior to the clinic visit compared with the previous 4 week period
(even if there was some initial deterioration).
2= THE SAME:
should be used for any item which was present in the
previous 4 week period and is still present, without obvious deterioration (such
that additional therapy might be considered) or significant improvement (such
that the physician is very satisfied with the patient’s progress, would not
consider any additional therapy and the above criteria are fulfilled.) If
improvement is less than 2 weeks, then overall the patient has been the same in
this 30 day period and should be scored 2 = the same.
3= WORSE:
should be used if the feature is currently deteriorating
or has deteriorated and then remained the same during this 30 day period; i.e.:
more severe symptoms for which additional therapy might be considered; this may
include additional skin lesions or oral ulcers or inflamed joints etc. (but note
that criteria for another BILAG item
may now be fulfilled and that item should be scored as 4=NEW. For example:
arthritis may deteriorate (score 3) and in addition, there is now polyarthritis
with loss of function, which is scored 4 (new).
4 = NEW:
If a new clinical feature has developed in the 4 week period prior to the
current assessment, it should be scored as 4 = NEW even if it has improved or
resolved by the time of this visit, or since the previous visit. In subsequent
BILAG assessments, a clinical feature will be classified as improved, same, or
worse. If a clinical feature resolves and is absent for 4 weeks, that feature
may then be scored as 0 = NOT PRESENT. If this feature then recurs at a later
date, it must then be scored as 4 = NEW at that later visit. BILAG may thus
capture the waxing and waning nature of SLE in a patient
NOT ANSWERED:
All questions should be answered, but in the event of a response to a
question being omitted during the assessment, then an estimated score should be
inserted, rather than a default of zero. This estimate should be based on the
previous assessment score for the question, but the clinician may feel that this
should be modified (positively or negatively), when the other responses in the
system are considered. | 
