OBJECTIVE: o determine if the variability of the Systemic Lupus Erythematosus 
Disease Activity Index 2000 (SLEDAI-2K), along with the Adjusted Mean SLEDAI-2K 
(AMS), can better predict major outcomes in SLE than the AMS alone.
METHODS: Patients were followed in the Lupus Clinic at 2-6 month intervals. 
Clinical and laboratory information necessary to compute the SLEDAI-2K and 
Systemic Lupus International Collaborating Clinics/American College of 
Rheumatology damage index was collected prospectively and entered onto a 
computerized database. Patients followed for a minimum of 3 visits, and without 
absence for a period > 18 consecutive months, were included in the study. Six 
different approaches to measure variability of SLEDAI-2K were evaluated for each 
visit, along with AMS. Approaches were the standard deviation, the slope, 
average rate of change by visit, the range, the coefficient of variation, and 
the Percentage of the visits with a change in SLEDAI-2K > or = 3. The SLE 
outcomes under study were death, presence of damage, coronary artery disease 
(CAD), and osteonecrosis (ON). The predictability of each outcome was evaluated 
through time-dependent covariate survival analyses. Regression models included 
other known major risk factors such as sex, age at diagnosis, SLEDAI-2K at 
presentation, and disease duration.
RESULTS: Five hundred seventy-five patients seen from 1970 to 2002 were 
included. The average time between visits was 4.0 +/- 2.2 months. Eighty-five 
patients died, 325 developed damage, 55 had CAD, and 68 had ON. None of the 6 
variability measures added more statistical significance in the prediction of 
any of the 4 outcomes. For the prediction of survival, AMS [hazard ratio (HR) = 
1.16, p < 0.0001] and age at diagnosis (HR 1.05, p < 0.0001) were the only 
significant risk factors. For presence of damage, AMS (HR 1.06, p < 0.0001), age 
at diagnosis (HR 1.02, p = 0.0004), and disease duration (HR 1.05, p < 0.0001) 
were predictors. CAD was predicted by AMS (HR 1.12, p = 0.0003), male sex (HR 
2.31, p = 0.02), age at diagnosis (HR 1.06, p < 0.0001), and disease duration 
(HR 1.10, p < 0.0001). For ON, SLEDAI-2K at presentation (HR 1.04, p = 0.003) 
and disease duration (HR 0.92, p = 0.05) were significant risk factors.
CONCLUSION: Multivariate analysis revealed that AMS, independent of variability 
of the SLEDAI-2K, is an important predictor of major outcomes in SLE.