SFDCT / Dow Settlement Disease Criteria

Lupus SLE - Option 2

A claim for SLE must include a diagnosis of SLE (lupus) made by a Board-certified rheumatologist based upon personal examination of the patient. [Exclusion: mild lupus (SLE not requiring regular medical attention including doctor visits and regular prescription medications).]

Supporting medical documentation must affirmatively reveal that at least four (4) of the following eleven (11) criteria are present:

Criterion Definition

1. Malar rash Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds.
2. Discoid rash Erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions.
3. Photosensitivity Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation
4. Oral ulcers Oral or nasopharyngeal ulceration, usually painless, observed by a physician.
5. Arthritis Nonerosive arthritis involving two or more peripheral joints, characterized by tenderness, swelling, or effusion. [Exclusion: erosive arthritis]
6. Serositis
   • Pleuritis -- convincing history of pleuritic pain or rub heard by a physician or evidence of pleural effusion, or
   • Pericarditis -- documented by ECG or rub or evidence of pericardial effusion.
7. Renal disorder
   • Persistent proteinuria greater than 0.5 grams per day or greater than three (3)+ if quantitation not performed, or
   • Cellular casts -- may be red cell, hemoglobin, granular, tubular, or mixed.
8. Neurologic disorder Seizures -- in the absence of offending drugs or known metabolic derangements, e.g. uremia, ketoacidosis, or electrolyte imbalance.
9. Hematologic disorder
   • Hemolytic anemia -- with reticulocytosis, or
   • Leukopenia -- less than 4,000/mm total on two (2) or more occasions, or
   • Lymphopenia -- less than 1,500/mm on two (2) or more occasions, or
   • Thrombocytopenia -- less than 100,000/mm in the absence of offending drugs.
10. Immunologic Disorder
    • Positive LE cell preparation, or
    • Anti-DNA: antibody to native DNA in abnormal titer, or
    • Anti-Sm: presence of antibody to Sm nuclear antigen, or
    • False positive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test
    • Anti-SS-A (Sjogrens blood-work)
11. Antinuclear antibody An abnormal titer or antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs known to be associated with "drug-induced lupus" syndrome.
12. Compensation Levels:
    • Death resulting from SLE, or severe chronic renal involvement manifested by a glomerular filtration rate of less than 50% of the age- and gender-adjusted norm, as measured by an adequate 24-hour urine specimen collection.
    • SLE with involvement of one (1) or more of the following: glomerulonephritis, seizures in the absence of offending drugs or known metabolic derangements, Lupus Psychosis, myocarditis, pneumonitis, thrombocytopenic purpura, hemolytic anemia (with hemoglobin of 10 grams or less), severe granulocytopenia (with a total white cell count less than 2000), or mesenteric vasculitis.
    • A diagnosis of lupus in accordance with the above criteria that does not involve the findings in A or B above. (Default compensation level.)