The British Isles Lupus Assessment Group (BILAG)-2004 index is a comprehensive disease activity instrument for systemic lupus erythematosus (SLE).¹ Its key advantages are the ability to capture rare as well as common features of SLE, to assess each organ separately, and to capture partial change in any feature. However, administrative burden and potential frequency of errors previously limited its use in routine practice.

Easy BILAG is a tool for more accurate, time efficient scoring of BILAG-2004 index with full fidelity to the existing instrument.² It is a simple one-page form designed to be completed quickly during a clinic consultation that guides the user through organ systems and provides an instant BILAG grade.

To develop Easy BILAG, frequency of BILAG-2004 items was collated from a BILAG-biologics registry (BILAG-BR) dataset.² Easy-BILAG prototypes were developed to address known issues affecting speed and accuracy. After expert verification, accuracy and usability of the finalised Easy-BILAG was validated against standard format BILAG-2004 in a workbook exercise of 10 case vignettes. Thirty-three professionals ranging in expertise from 14 UK centres completed the validation exercise. Easy-BILAG incorporates all items present in ≥5% BILAG-BR records, plus full constitutional and renal domains, into a rapid single page assessment. An embedded glossary and colour-coding assists domain scoring. A second page captures rarer manifestations when needed. In the validation exercise, Easy-BILAG yielded higher median scoring accuracy (96.7%) than standard BILAG-2004 documentation (87.8%, p=0.001), with better inter-rater agreement.² Easy-BILAG was completed faster (59.5 minutes) than the standard format (80.0 minutes, p=0.04) for 10 cases. An advantage in accuracy was observed with Easy-BILAG use among general hospital rheumatologists (91.3% vs 75.0%, p=0.02), leading to equivalent accuracy as tertiary centre rheumatologists.² Clinicians rated Easy-BILAG as intuitive, convenient, and well adapted for routine practice.

In conclusion, Easy-BILAG facilitates more rapid and accurate scoring of BILAG-2004 across all clinical settings, which could improve patient care and biologics prescribing. Easy-BILAG should be adopted wherever BILAG-2004 assessment is required.

References

1. Yee CS, Farewell V, Isenberg DA, et al. British isles lupus assessment group 2004 index is valid for assessment of disease activity in systemic lupus erythematosus. Arthritis Rheum. 2007;56(12):4113–9. doi: 10.1002/art.23130.

2. Carter LM, Gordon C, Yee CS, et al. Easy-BILAG: A new tool for simplified recording of SLE disease activity using BILAG-2004 index. Rheumatology (Oxford). 2022;61(10):4006–15. doi: 10.1093/rheumatology/keab883.

Learning Objectives At the end of this presentation participants will be able to:

• Discuss how BILAG can be used to document a complete lupus assessment in clinical practice

• Explain how to use the Easy-BILAG tool for rapid lupus assessment

• Describe the advantages of BILAG compared to other instruments