International consensus for a definition of disease flare in lupus

Research output: Contribution to journalArticle


  • 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
  • J Grossman
  • B Hahn
  • DA Isenberg
  • KC Kalunian
  • M Petri
  • L Sammaritano
  • J Sanchez-Guerrero
  • RD Sontheimer
  • V Strand
  • M Urowitz
  • JM von Feldt
  • VP Werth
  • JT Merrill

Colleges, School and Institutes


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