Severity Level
Conditions
– Arthritis: Non-erosive arthritis involving two or more peripheral joints, characterised by tenderness, swelling, or effusion. – Serositis: Pleuritis - convincing history of pleuritic pain or pleuritic rub heard by a physician or evidence of pleural effusion; or pericarditis - documented by ECG or rub or evidence of pericardial effusion. – Renal disorder: Persistent proteinuria greater than 0.5 grams per day; or greater than 2+ if quantitation not performed; or tubular casts - may be red cell, haemoglobin, granular, cellular or mixed. – Neurological disorder: Seizures - in the absence of offending drugs or known metabolic derangements, e.g. uraemia, ketoacidosis; or electrolyte imbalance. – Hematologic disorder: Hemolytic anaemia - with reticulocytosis; or leucopoenia - less than 3,500/mm3 on two (2) or more occasions; or thrombocytopenia - less than 100,000mm3 in the absence of offending drugs. – Immunologic disorder: Positive LE cell preparation; or anti-DNA: antibody to native DNA in abnormal titre; or anti-Sm: presence of antibody to Sm (Smooth Muscle) nuclear antigen; or false positive serologic test for syphilis known to be positive for at least six (6) months and confirmed by Treponema pallidum immobilisation or fluorescent treponemal antibody absorption test. – Antinuclear antibody: An abnormal titre of 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. – Alopecia: Diffuse thinning and fragility of the hair in the absence of other causes (such as alopecia areata, drugs, iron deficiency and androgenic alopecia). In addition to the diagnosis of systemic lupus erythematosus, lupus nephritis must be confirmed by renal changes as measured by a renal biopsy that it is grade 3 to 5 of the World Health Organisation (WHO) classification of lupus nephritis and be associated with persisting proteinuria (more than 2+).
Severe ulcerative colitis means diagnosis of ulcerative colitis that requires permanent immunosuppressive medication.
Severe Crohn’s disease means diagnosis of Crohn’s disease that requires permanent immunosuppressive medication.
Severe osteoporosis means that the life assured before the age of 50 has been unequivocally diagnosed by an appropriate specialist as suffering from severe osteoporosis. The diagnosis must confirm that the life assured :
– Suffers at least two vertebral body fractures or a fracture of the neck or the femur, due to osteoporosis; and
– Has a bone mineral density reading with a T-score of less than -2.5 (i.e. 2.5 standard deviations below the young adult mean for bone density). This must be measured in at least two sites by dual energy x-ray absorptiometry (DEXA).
– An exclusion applies in cases where there are spontaneous fractures or minimal traumas that are due to an accident but where coincidental osteoporosis exists.
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Severe rheumatoid arthritis means that the life assured before age 50 has been unequivocally diagnosed by an appropriate specialist as suffering from severe rheumatoid arthritis for at least six weeks, which affects at least three or more of the following joints:
– Metacarpophalangeal joints in the hands;
– Proximal interphalangeal joints in the hands; and
– Metatarsophalangeal joints in the wrist, elbow, foot, knee, or ankle.
The diagnosis must be supported by a positive rheumatoid serology or other appropriate diagnostic test evidencing rheumatoid arthritis, together with evidence confirming at least three of the following criteria:
– Simultaneous bilateral and symmetrical joint soft tissue swelling or fluid;
– Joint deformity typical of rheumatoid arthritis;
818 TCP-PC version 12 Effective 12 May 2026
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