Validation of proposals for definitions of moderate and severe disease activity in SLE: impact on flares, quality of life, damage accrual, hospitalisations and mortality

MODAS and SEDAS offer an alternative framework for defining moderate and severe SLE activity, with modest but consistent improvements in predictive performance compared with SLEDAI. By integrating cSLEDAI, key severe features and physician judgement, they improve prognostic performance and support a severity-based approach to clinical management and research. Their clinical utility remains preliminary, and further external validation is required before routine implementation.