Study No Date Data JSLE - MINI BILAG (Page 1 of 4)
Study No Date Data JSLE - MINI BILAG (Page 1 of 4)
Study No Date Data JSLE - MINI BILAG (Page 1 of 4)
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Haematology<br />
131 Haemoglobin g/dl<br />
132 Total white cell count x 10 9 /l<br />
133 Neutrophils x 10 9 /l<br />
134 Lymphocytes x 10 9 /l<br />
135 Platelets x 10 9 /l<br />
136 Evidence <strong>of</strong> active haemolysis Y N<br />
137 Coomb's test positive Y N<br />
138 Evidence <strong>of</strong> circulating anticoagulant Y N<br />
Other measures <strong>of</strong> disease activity<br />
ESR (mm/hr)<br />
CRP<br />
C3 (g/l)<br />
C4 (g/l)<br />
IgG<br />
IgA<br />
IgM<br />
dsDNA done (IU/ml)<br />
<strong>JSLE</strong> - <strong>MINI</strong> <strong>BILAG</strong> (<strong>Page</strong> 4 <strong>of</strong> 4)<br />
Treatment<br />
Hydroxychloroquine<br />
Current dose Revised dose<br />
Azathioprine<br />
Mycophenolate<br />
Cyclosporin A<br />
Prednisolone<br />
Methotrexate<br />
IVIG<br />
Rituximab (mg/m 2 )<br />
Cyclophosphamide<br />
IV IV<br />
Oral Oral<br />
Subcut Subcut<br />
IV Oral<br />
IV MePred in last 3 months < 5 pulses >= 5 pulses<br />
Other Aspirin Bisphosphonate<br />
drugs<br />
Oral contraceptive pill<br />
Angiotensin receptor blocker<br />
Ca ++ blockers Statins<br />
Function<br />
Patient CHAQ/HAQ Global assessment on CHAQ/HAQ<br />
(0: Very well - 100 - Very ill)<br />
Current Total number <strong>of</strong><br />
dose Pulses to date<br />
Cumulative Total number <strong>of</strong><br />
dose Pulses to date<br />
ACEi Diuretic<br />
Physicians<br />
global score Very well Very ill<br />
Survey : 7120 Serial : 1 <strong>Page</strong> : 4<br />
UK <strong>JSLE</strong> <strong>Study</strong> Group © - Version 2
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