Description
The BILAG-2004 is regarded as the most comprehen- sive disease activity index currently used in SLE. However, its complexity can limit the efficiency and ac- curacy of scoring, and this has both posed a barrier to its broader adoption and potentially impacted on its util- ity as part of the standard clinical trial endpoints. In this issue of Rheumatology, Carter and colleagues describe development and initial accuracy and usability testing of a more streamlined version of the BILAG-2004 [1]. Dubbed the 'Easy-BILAG', this new version is proposed as the recommended format for scoring the BILAG-2004 index in routine clinical care.
The BILAG-2004 is an organ-based scale with grada- tions of severity based on physician intention-to-treat. It covers nine organ systems and comprises 97 items defined in an extensive glossary. Each item is scored as new/recurrence, worse, same, improving or not present during the most recent month, relative to the month prior. These scores are integrated in an algorithm result- ing in each organ being assigned a grade from A to E, where A, B and C represent major, intermediate and mild disease activity, respectively: D represents previous involvement that is currently inactive; and E represents no previous activity [2]. The proposed 'Easy-BILAG maintains full fidelity to the BILAG-2004, which has been well-studied in regard to reliability and construct validity [3], but with changes in scoring format intended to en- hance accuracy and feasibility. These changes, proto- typed based on feedback from expert clinicians, are several, and include (1) grouping of items based on their frequency to allow better visibility and prioritization of common manifestations; (ii) the ability to derive A-E grading at the time of assessment, which eliminates the opacity of the previous computer-based algorithm; and (iii) an optional self-adjudication checklist that draws at- tention to common scoring errors.
ISBN: RHEUMATOLOGY
