International consensus for a definition of disease flare in lupus

N. Ruperto, L. M. Hanrahan, G. S. Alarcón, H. M. Belmont, R. L. Brey, P. Brunetta, J. P. Buyon, M. I. Costner, M. E. Cronin, M. A. Dooley, G. Filocamo, D. Fiorentino, P. R. Fortin, A. G. Franks, G. Gilkeson, E. Ginzler, C. Gordon, J. Grossman, B. Hahn, D. A. IsenbergK. C. Kalunian, M. Petri, L. Sammaritano, J. Sánchez-Guerrero, R. D. Sontheimer, V. Strand, M. Urowitz, J. M. Von Feldt, V. P. Werth, J. T. Merrill

Research output: Contribution to journalArticlepeer-review

104 Scopus citations


The Lupus Foundation of America (LFA) convened an international working group to obtain a consensus definition of disease flare in lupus. With help from the Paediatric Rheumatology International Trials Organization (PRINTO), two web-based Delphi surveys of physicians were conducted. Subsequently, the LFA held a second consensus conference followed by a third Delphi survey to reach a community-wide agreement for flare definition. Sixty-nine of the 120 (57.5%) polled physicians responded to the first survey. Fifty-nine of the responses were available to draft 12 preliminary statements, which were circulated in the second survey. Eighty-seven of 118 (74%) physicians completed the second survey, with an agreement of 70% for 9/12 (75%) statements. During the second conference, three alternative flare definitions were consolidated and sent back to the international community. One hundred and sixteen of 146 (79.5%) responded, with agreement by 71/116 (61%) for the following definition: "A flare is a measurable increase in disease activity in one or more organ systems involving new or worse clinical signs and symptoms and/or laboratory measurements. It must be considered clinically significant by the assessor and usually there would be at least consideration of a change or an increase in treatment." The LFA proposes this definition for lupus flare on the basis of its high face validity.

Original languageEnglish (US)
Pages (from-to)453-462
Number of pages10
Issue number5
StatePublished - Apr 2011


  • autoimmune disease
  • flare
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology


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