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Grading Organ Involvement & Middlesex Score for Disease Activity in SLE

Purpose: To grade skin, cerebral and renal involvement in a patient with systemic lupus erythematosus(SLE) for the UCH/Middlesex disease activity score.

Description

Morrow et al developed a score for grading disease activity in systemic lupus erythematosus (SLE). Three items involve determining activity in individual organs affected by SLE. The authors are from University College Hospital (UCH) and Middlesex Hospital in London.


Parameters:

(1) vasculitis skin rash grade

(2) cerebral involvement grade

(3) renal involvement grade

 

Skin Findings

Skin Grade

rash <= 44% of BSA and no “changes” (see below)

1

healing phase of Grade 2 or 3

1

rash > 44% of BSA and no “changes”

2

any skin changes (infarction, ulceration, trophic changes)

3

 

 

Neurological Findings

Cerebral Grade

frequent vascular headaches and/or visual phenomena

1

healing phase of Grade 2 or 3

1

mood disturbance with normal functioning OR impaired consciousness with normal functioning

2

neurological deficit within past month OR mood disturbance unable to function normally OR impaired consciousness unable to function normally

3

 

 

Proteinuria

Diastolic Blood Pressure

Serum Creatinine

Renal Grade

trace

normal or increased, stable

stable

1

more than trace and stable

normal or increased, stable

stable

2

more than trace and increasing

stable or rising

stable or rising

3

 

where:

• An increased diastolic blood pressure is > 90 mm Hg.


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Specialty

Objective

ICD-10