The MID in patients with SLE may be different bidirectionally depending on the measured outcome. The mean change observed for those reporting better than worse outcome in pain and fatigue was greater for better versus worst, in contrast to the HAQ, where the mean change was greater for worsening.

There could have been recall bias and participants may have confused pre-menstrual syndrome with flares. However, there seem to be menstrual cycle flares in SLE, RA and FM.