Question 1

What is the advantage of BILAG over SLEDAI?

Accepted Answer

BILAG distinguishes new/worsening features from ongoing stable activity, making it more sensitive to partial flares. SLEDAI treats all present features equally regardless of recency. BILAG also organises activity by system, which directly guides treatment.

Question 2

How long does a BILAG assessment take?

Accepted Answer

5–10 minutes for an experienced user. The 97-item checklist is comprehensive but most systems can be scored quickly if the patient has no new features.

Question 3

Can BILAG be used retrospectively from medical records?

Accepted Answer

The BILAG-2004 is designed for prospective use. Retrospective scoring from charts has been done in research but has lower reliability, particularly for subjective features.

Question 4

How are treatment decisions linked to BILAG grades?

Accepted Answer

System A (severe) generally warrants high-dose corticosteroids plus immunosuppressant escalation (MMF, cyclophosphamide, rituximab). System B generally warrants moderate-dose corticosteroids or adjustment of existing immunosuppressants.