Performance of the systemic lupus erythematosus disease activity score (SLE-DAS) in daily clinical practice: A prospective study of 125 patients in India

Background Accurate measurement of disease activity is a cornerstone in the management of patients with Systemic Lupus Erythematosus (SLE), to assist in guiding therapeutic decisions. SLE-DAS (SLE Disease Activity Score) is designed to improve accuracy and sensitivity to change compared with the standard SLE Disease Activity Index (SLEDAI) score. Objectives We aimed to assess the performance of SLE-DAS to identify flare and clinically meaningful improvement (CMI) in real-life SLE patients in India. Methods Prospective observational study at an Indian Rheumatology Clinic included SLE patients meeting 2012 SLICC and/or 2019 ACR/EULAR criteria, followed for 9 months. At baseline and subsequent follow-up, we recorded SLEDAI-2K, SLE-DAS, PGA, LLDAS, DORIS remission, prednisolone dose, and immunosuppressives; SELENA-SLEDAI flare index (SFI) was evaluated at follow-up. We assessed Spearman correlation, agreement, and discrepancies between SLEDAI and SLE-DAS for flare and improvement detection using an agreement matrix. Results A strong correlation was observed between SLEDAI-2K and SLE-DAS (rho = 0.954, 95% CI 0.934–0.968, p < 0.001). SLE-DAS identified CMI in 42.0% of visits compared to 34.8% by SLEDAI-2K. Flare detection sensitivity was higher for SLE-DAS (96%) than SLEDAI-2K (84%), with similar specificity (98.9%). The agreement of SLEDAS remission and low disease activity (LDA) with DORIS remission and LLDAS, respectively, was perfect (κ = 1, p < 0.001). Discordant analysis revealed that SLEDAI-2K underestimated severe flares and missed manifestations such as pneumonitis, AIHA, and serositis. Conclusion SLE-DAS demonstrated superior sensitivity, granularity, and remission alignment compared to SLEDAI-2K, supporting its adoption as a primary clinical index in diverse real-world lupus practices.