OBJECTIVE: Current disease activity measures for systemic lupus erythematosus 
(SLE) are difficult to score or interpret and problematic for use in clinical 
practice. Lupus Foundation of America (LFA)-Rapid Evaluation of Activity in 
Lupus (REAL) is a pilot application composed of anchored visual analogue scores 
(0-100 mm each) for each organ affected by lupus. This study evaluated the use 
of LFA-REAL in capturing SLE disease activity.
METHODS: In a preliminary test of LFA-REAL, this simplified, organ-based system 
was compared with the most widely used outcome measures in clinical trials, the 
British Isles Lupus Assessment Group 2004 Index (BILAG), the SLE Disease 
Activity Index (SLEDAI) and the Safety of Estrogens in Lupus Erythematosus 
National Assessment (SELENA) SLEDAI Physician's Global Assessment (SS-PGA). The 
level of agreement was analysed using Spearman rank correlations.
RESULTS: 91 patients with SLE with mild to severe disease activity were 
evaluated, their median SLEDAI score was 4.0 (range 0-28) and BILAG score 8.0 
(0-32). The median SS-PGA was 38 mm (4-92) versus the total REAL 50 mm (0-268), 
which expands in range by additive organ scores. Thirty-three patients had 
moderate to severe disease activity (≥1.5 on SS-PGA landmarks). The median 
SS-PGA score of this group was 66 mm (50-92) versus median REAL score of 100 mm 
(59-268), confirming ability to detect a wider distribution of scores at higher 
disease activity. Total REAL correlated with SLEDAI, BILAG and SS-PGA 
(correlation coefficient=0.816, 0.933 and 0.903, respectively; p<0.001 for all). 
Individual LFA-REAL organ scores for musculoskeletal and mucocutaneous also 
correlated with corresponding BILAG domain scores (correlation coefficient=0.925 
and 0.934, p<0.001).
CONCLUSIONS: In this preliminary exercise, there were strong correlations 
between LFA-REAL and validated lupus disease activity indices. Further 
development may be valuable for consistent scoring in clinical trials, grading 
optimal assessment of change in disease activity and reliable monitoring of 
patients in practice.