International consensus for a definition of disease flare in lupus

N Ruperto, LM Hanrahan, GS Alarcon, HM Belmont, RL Brey, P Brunetta, JP Buyon, MI Costner, ME Cronin, MA Dooley, G Filocamo, D Fiorentino, PR Fortin, AG Franks, G Gilkeson, E Ginzler, Caroline Gordon, J Grossman, B Hahn, DA IsenbergKC Kalunian, M Petri, L Sammaritano, J Sanchez-Guerrero, RD Sontheimer, V Strand, M Urowitz, JM von Feldt, VP Werth, JT Merrill

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104 Citations (Scopus)


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. Lupus (2011) 20, 453-462.
Original languageEnglish
Pages (from-to)453-462
Number of pages10
Issue number5
Publication statusPublished - 1 Apr 2011


  • autoimmune disease
  • systemic lupus erythematosus
  • flare


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