OBJECTIVE: To develop and validate a modification of SLEDAI-2K to accurately 
describe disease activity while accounting for glucocorticoid (GC) doses.
METHODS: The first two phases focused on the development of the index. Phase 1: 
identification of scenarios of real patients seen prospectively in a 
longitudinal cohort. Phase 2: derivation of an equation that explains the 
association between SLEDAI-2K and GC doses using physician global assessment as 
the external construct. Phase 3: comparison of SLEDAI-2K and SLEDAI-2K GC 
(SLEDAI-2KG), using different cut-off points (4-7), in identifying responders in 
response to therapy.
RESULTS: In phase 1, 150 scenarios with different organ involvement and a range 
of GC doses were identified. In phase 2, three rheumatologists ranked disease 
activity using physician global assessment. A quadratic linear regression model 
relating GC doses and SLEDAI-2K resulted in the following equation: SLEDAI-2KG 
score = SLEDAI-2K score + [0.32 × GC - 0.0031 × GC2]. The weighted score of 
different GC doses was derived. In phase 3, SLEDAI-2KG identified more 
responders in a total of 111 patients at 6 months (84 vs 93%) and at 12 months 
(76 vs 92%) compared with SLEDAI-2K. SLEDAI-2KG performances were superior to 
SLEDAI-2K with all cut-off points (5-7).
CONCLUSION: We developed a modification of SLEDAI-2K, SLEDAI-2KG, that describes 
disease activity while accounting for GC dose category. SLEDAI-2KG identifies 
more responders compared with SLEDAI-2K.