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Evolving concepts in systemic lupus erythematosus damage assessment

An Author Correction to this article was published on 27 April 2021

This article has been updated

The Systemic Lupus International Collaborating Clinics–ACR Damage Index (SDI) has been widely used for 25 years. This index, however, has its limitations, providing a rationale for a global initiative to create a revised, updated SDI to capture organ damage across the age-spectrum.

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Fig. 1: The development of SLE and consequent accrual of organ damage.

Change history


  1. 1.

    Strand, V. et al. Endpoints: consensus recommendations from OMERACT IV. Lupus 9, 322–327 (2000).

    CAS  Article  Google Scholar 

  2. 2.

    Gladman, D. 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. 39, 363–369 (1996).

    CAS  Article  Google Scholar 

  3. 3.

    Parker, B. & Bruce, I. N. in Dubois’ Lupus Erythematosus and Related Syndromes (eds D. J. Wallace & Hahn, B. H.) Ch. 49, 614–630 (2019).

  4. 4.

    Barber, M. R. W. et al. Economic evaluation of damage accrual in an international SLE inception cohort using a multi-state model approach. Arthritis Care Res. (Hoboken) 72, 1800–1808 (2019).

    Article  Google Scholar 

  5. 5.

    Van Vollenhoven, R. F. et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann. Rheum. Dis. 73, 958–967 (2014).

    Article  Google Scholar 

  6. 6.

    Mahieu, M. A., Strand, V., Simon, L. S., Lipsky, P. E. & Ramsey-Goldman, R. A critical review of clinical trials in systemic lupus erythematosus. Lupus 25, 1122–1140 (2016).

    CAS  Article  Google Scholar 

  7. 7.

    Touma, Z., Urowitz, M. B., Ibanez, D. & Gladman, D. D. Time to recovery from proteinuria in patients with lupus nephritis receiving standard treatment. J. Rheumatol. 41, 688–697 (2014).

    CAS  Article  Google Scholar 

  8. 8.

    Holland, M. J. et al. Measuring disease damage and its severity in childhood-onset systemic lupus erythematosus. Arthritis Care Res. 70, 1621–1629 (2018).

    Article  Google Scholar 

  9. 9.

    Sutton, E. J., Davidson, J. E. & Bruce, I. N. The systemic lupus international collaborating clinics (SLICC) damage index: a systematic literature review. Semin. Arthritis Rheum. 43, 352–361 (2013).

    Article  Google Scholar 

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The authors acknowledge funding support from the Lupus Foundation of America and the ACR. INB is a National Institute for Health Research (NIHR) Senior Investigator and is funded by the NIHR Manchester Biomedical Research Centre. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.

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Correspondence to Ian N. Bruce.

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Competing interests

M.R.W.B has received consulting fees from Janssen and Sanofi Genzyme. S.R.J. has received consulting fees from Boehringer Ingelheim and Ikaria. D.D.G. has received grants from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer and UCB, and consulting fees from AbbVie, Amgen, BMS, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer and UCB. A.E.C. has received consulting fees from AstraZeneca, Exagen Diagnostics, BristolMyersSquibb and GSK. I.N.B. has received grant support from Genzyme/Sanofi, GSK, Roche and UCB; consulting fees from AstraZeneca, Eli Lilly, GSK, Merck Serono, UCB and ILTOO; and was a speaker for AstraZeneca, GSK and UCB.

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Barber, M.R.W., Johnson, S.R., Gladman, D.D. et al. Evolving concepts in systemic lupus erythematosus damage assessment. Nat Rev Rheumatol 17, 307–308 (2021).

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