The clinical-decision-support language in this prototype is anchored to the citations in this section. The following paragraphs describe how each model output should be read against current rheumatology practice, and underpin the brief lines shown in the Suggested actions panel and the workflow steps in Clinical handoff. Lupus assessment in routine practice may also draw on the BILAG-2004 index, the 1997 ACR revised classification criteria, and organ-specific guidance such as the KDIGO 2024 lupus nephritis recommendations, all cited below.
Diagnosis. The expression profile is compared to the SLE reference cohort. A low signal does not rule out SLE when clinical suspicion remains; a high signal still requires confirmation against the 2019 EULAR/ACR classification criteria — ANA entry, organ domains, haematology, anti-dsDNA/anti-Sm, complement consumption — and exclusion of infection, drug-induced lupus, and overlap syndromes before labelling or initiating SLE-directed therapy (Aringer et al., 2019).
Progression. Interpret the next-visit activity probability against the SLEDAI-2K trend, anti-dsDNA, C3/C4, urinalysis ± urine protein-to-creatinine ratio (UPCR), and any new organ involvement. A rising probability with falling complement, rising anti-dsDNA, or an active urinary sediment supports a true flare and warrants earlier review; escalation should follow EULAR 2023 (continue hydroxychloroquine, minimise glucocorticoid exposure, add MMF/AZA/belimumab/anifrolumab where indicated). BILAG-2004 may be used in parallel where local practice prefers a domain-based activity index (Gladman et al., 2002; Fanouriakis et al., 2024; Yee et al., 2010).
Treatment response. Read the response probability alongside SLEDAI-2K, serology, and tolerability at the expected response timepoint. A low or off-target signal in a patient who is not at LLDAS/DORIS should prompt review of hydroxychloroquine adherence, glucocorticoid stewardship (aim ≤5 mg/day prednisolone-equivalent), and escalation per EULAR 2023 — adding or switching to belimumab, anifrolumab, MMF, or AZA as clinically indicated. Lupus-nephritis specifics follow the KDIGO 2024 guideline (Fanouriakis et al., 2024; Franklyn et al., 2016; van Vollenhoven et al., 2021; KDIGO, 2024).