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 patientís 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.
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
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.