Instruments to Measure Disease Activity in Systemic Lupus Erythematosus — Is Our Net Tight Enough to Catch the Hydra?

Abstract

The Hydra of Greek mythology, a beast with multiple heads that grow again when cut off, has been suggested by Isenberg, et al 1 to be a model of systemic lupus erythematosus (SLE). In analogy with the Hydra, SLE can present itself in a multitude of guises, usually intermittently active, with sometimes abrupt flares, sometimes prolonged periods of active disease, as well as periods of clinical remission. However, there is always a risk that the disease will reappear. Active disease may cause organ damage, and disease activity over time has been shown to be strongly associated with mortality and organ damage2. Good instruments for monitoring disease activity, organ damage, and health status are required for adequate followup of longterm outcome and judgment of response to treatment. At every patient visit the physician should decide whether the patient’s disease is active and whether disease activity is the same, better, or worse compared with the previous visit. Further, annual assessment of organ damage and quality of life should be done to enable a complete evaluation of therapeutic response and prognostic considerations. A multitude of suggestions for disease activity assessment in SLE have been presented over … Address reprint request to Dr. Sturfelt; E-mail: Gunnar.Sturfelt{at}med.lu.se