Comparing the 1997 update of the 1982 American College of Rheumatology (ACR-97) and the 2012 Systemic Lupus International Collaborating Clinics (SLICC-12) criteria for systemic lupus erythematosus (SLE) classification: which enables earlier classification of SLE in an urban Asian population?

Lupus ◽  
2018 ◽  
Vol 28 (1) ◽  
pp. 11-18 ◽  
Author(s):  
E S H Low ◽  
G Krishnaswamy ◽  
J Thumboo
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Clinical Care ◽  
Asian Population ◽  
Disease Classification ◽  
Systemic Lupus ◽  
Asian Patients ◽  
American College Of Rheumatology ◽  
Nested Case Control

Objective We compared the 1997 update of the 1982 American College of Rheumatology (ACR-97) and the 2012 Systemic Lupus International Collaborating Clinics (SLICC-12) criteria, for earlier classification of systemic lupus erythematosus (SLE) in a multiethnic urban Asian SLE population. Methods Patients from a retrospective, nested case-control study of the influence of lupus nephritis on mortality in SLE were studied. For each patient, dates of first manifestations of each criteria (both ACR-97 and SLICC-12) were recorded, and the date of disease classification using ACR-97 or SLICC-12 criteria was compared to determine which criteria resulted in earlier classification. Results Among 182 SLE patients (74.2% Chinese, 18.1% Malay, 4.4% Indian and 3.3% Other ethnicities), 10 (5.5%) did not fulfill the ACR-97 criteria and 2 (1.1%) did not fulfill the SLICC-12 criteria. Using the SLICC-12 criteria, 18% of subjects showed earlier classification, whereas 7% of subjects showed earlier classification using the ACR-97 criteria. The SLICC hematologic criteria of “Leukopenia or lymphopenia” contributed most significantly to earlier diagnosis by SLICC-12. “Leukopenia or lymphopenia'' was present in 59% (19/32) of patients where SLICC-12 criteria allowed for earlier classification than ACR-97, compared with 15.4% (2/13) of patients where ACR-97 allowed earlier classification than SLICC-12 ( p = 0.02). The immunologic criterion that is considered a strength of the SLICC-12 criteria did not appear to contribute significantly to earlier diagnosis in this study. Conclusion SLICC-12 criteria allow for earlier classification of SLE in a multiethnic cohort of Asian patients, supporting the validity of the SLICC-12 criteria and its use in clinical care and research.

Use of Consensus Methodology to Determine Candidate Items for Systemic Lupus Erythematosus Classification Criteria

2018 ◽  
Vol 46 (7) ◽  
pp. 721-726 ◽  
Author(s):  
Sindhu R. Johnson ◽  
Dinesh Khanna ◽  
David Daikh ◽  
Ricard Cervera ◽  
Nathalie Costedoat-Chalumeau ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Clinical Care ◽  
Nominal Group Technique ◽  
Steering Committee ◽  
Classification Criteria ◽  
Nominal Group ◽  
Systemic Lupus ◽  
High Performing ◽  
American College Of Rheumatology

Objective.Given the complexity and heterogeneity of systemic lupus erythematosus (SLE), high-performing classification criteria are critical to advancing research and clinical care. A collaborative effort by the European League Against Rheumatism and the American College of Rheumatology was undertaken to generate candidate criteria, and then to reduce them to a smaller set. The objective of the current study was to select a set of criteria that maximizes the likelihood of accurate classification of SLE, particularly early disease.Methods.An independent panel of international SLE experts and the SLE classification criteria steering committee (conducting SLE research in Canada, Mexico, United States, Austria, Germany, Greece, France, Italy, and Spain) ranked 43 candidate criteria. A consensus meeting using nominal group technique (NGT) was conducted to reduce the list of criteria for consideration.Results.The expert panel NGT exercise reduced the candidate criteria for SLE classification from 43 to 21. The panel distinguished potential “entry criteria,” which would be required for classification, from potential “additive criteria.” Potential entry criteria were antinuclear antibody (ANA) ≥ 1:80 (HEp-2 immunofluorescence), and low C3 and/or low C4. The use of low complement as an entry criterion was considered potentially useful in cases with negative ANA. Potential additive criteria included lupus nephritis by renal biopsy, autoantibodies, cytopenias, acute and chronic cutaneous lupus, alopecia, arthritis, serositis, oral mucosal lesions, central nervous system manifestations, and fever.Conclusion.The NGT exercise resulted in 21 candidate SLE classification criteria. The next phases of SLE classification criteria development will require refinement of criteria definitions, evaluation of the ability to cluster criteria into domains, and evaluation of weighting of criteria.

scholarly journals New Classification Criteria for Systemic Lupus Erythematosus

2020 ◽  
Vol 95 (3) ◽  
pp. 151-161
Author(s):  
Yeon-Ah Lee
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Clinical Findings ◽  
Classification Criteria ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
Acr Criteria ◽  
European League Against Rheumatism ◽  
Sum Score

Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with highly variable clinical and immunological manifestations. Classification and diagnosis of SLE are complicated by the multi-organ nature of the disease and by our incomplete understanding of its pathophysiology. The 1997 update of the 1982 American College of Rheumatology (ACR) criteria for SLE has been widely used for classification of SLE. In order to improve clinical relevance and early diagnosis, the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) group suggested the 2012 SLICC criteria. These sets of classification criteria have unweighted lists of various serological and clinical findings typical of SLE, can be fulfilled by reaching a sum score of points. The only exception is biopsy-proven lupus nephritis with autoantibodies in the 2012 SLICC criteria. In an attempt to overcome limitations of the previous sets of SLE classification criteria, the new 2019 SLE European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for SLE have been recently published. The 2019 EULAR/ACR criteria include positive ANA at least once as obligatory entry criterion; followed by additive hierarchically clustered and weighted criteria. The structure and weighting of criteria constitute a paradigm shift in the classification of SLE. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%. This review attempts to delineate the history, performance and limitations of the current sets of SLE criteria.

scholarly journals POS1295 PERFORMANCE OF 2019 EULAR/ACR CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS IN A PEDIATRIC POPULATION – A MULTICENTER STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 929.1-929
Author(s):  
Y. Levinsky ◽  
M. Broide ◽  
S. Kagan ◽  
O. Goldberg ◽  
O. Scheuerman ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Pediatric Patients ◽  
Classification Criteria ◽  
Systemic Lupus ◽  
Juvenile Onset ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Onset Systemic Lupus Erythematosus

Background:The “European League Against Rheumatism” and “American College of Rheumatology” 2019 (EULAR/ACR-19) criteria for the diagnosis of Systemic Lupus Erythematosus (SLE) were recently published, with the stated goal of maintaining the level of sensitivity and raising the level of specificity for classification of SLE in adults.Objectives:We aimed to examine the function of the new EULAR/ACR-19 criteria in a population of children and compare them to the SLICC-12 and ACR-97 criteria.Methods:In this multicenter study the charts of jSLE patients from three tertiary medical centers were reviewed and compared to patients with non-jSLE diagnosis. Pediatric rheumatologists, blinded to the original diagnosis, reviewed and diagnosed all cases. Pediatric patients’ clinical and laboratory data were retrospectively extracted and then examined with regard to how they met the new and old criteria.Results:Included were 225 patients (112 jSLE, 113 non-SLE). When applied to juvenile SLE classification, the sensitivity of the new EULAR/ACR-19 criteria was 0.96 (0.9-.0.99) and the specificity was 0.89 (0.82-0.94). These were comparable to the Systemic Lupus International Collaborating Clinics (SLICC) criteria. The sensitivity of the EULAR/ACR-19 criteria improves over time and was 0.83 twelve months following disease onset, reaching 0.96 after longer than 24 months.Conclusion:Among a cohort of jSLE patients, sensitivity of the new EULAR/ACR-19 criteria was found to be high and specificity may have improved slightly compared to the SLICC-12 criteria. We support the use of the new classification criteria for pediatric patients in future jSLE studies, but it should be noted that its specificity is lower than for adults.ACR-97SLICC-12EULAR/ACR-19Sensitivity (95% CI)0.79 (0.70-0.86)0.96 (0.9-0.99)0.96 (0.9-.0.99)Specificity (95% CI)0.94 (0.88-0.97)0.85 (0.77-0.91)0.89 (0.82-0.94)Accuracy (95% CI)0.86 (0.81-0.9)0.9 (0.86-0.94)0.92 (0.88-.0.96)Positive Likelihood Ratio (95% CI)12.7(6.1-26.2)6.35(4.1-9.9)9.0 (5.3-15.4)Negative Likelihood Ratio (95% CI)0.23(0.16-0.33)0.05(0.02-0.12)0.05(0.02-0.12)Diagnostic odds ratio (95% CI)55.5(22.80-135.0)120.85(43.0-340.0)180.1(61.3-529.4)References:[1]Smith EMD, Lythgoe H, Midgley A, Beresford MW, Hedrich CM. Juvenile-onset systemic lupus erythematosus: Update on clinical presentation, pathophysiology and treatment options. Clin Immunol 2019 published on December 2019. doi: 10.1016/j.clim.2019.108274[2]Massias JS, Smith EMD, Al-Abadi E, Armon K, Bailey K, Ciurtin C, et al. Clinical and laboratory characteristics in juvenile-onset systemic lupus erythematosus across age groups. Lupus 2020;29(5):474–81.[3]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997 Sep;40(9):1725[4]Petri M, Orbai AM, Alarcõn GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012 Aug;64(8):2677-86[5]Hartman EAR, van Royen-Kerkhof A, Jacobs JWG, Welsing PMJ, Fritsch-Stork RDE. Performance of the 2012 Systemic Lupus International Collaborating Clinics classification criteria versus the 1997 American College of Rheumatology classification criteria in adult and juvenile systemic lupus erythematosus. A systematic review and meta-an. Autoimmun Rev. 2018;17(3):316–22.[6]Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol 2019;71(9):1400–12.Disclosure of Interests:None declared

scholarly journals DIAGNOSTIC VALUE OF SYSTEMIC LUPUS ERYTHEMATOSUS CLASSIFICATION CRITERIA (AMERICAN COLLEGE OF RHEUMATOLOGY, 1997)

2020 ◽  
pp. 17-22
Author(s):  
U. Abrahamovych ◽  
O. Abrahamovych ◽  
O. Nadashkevych ◽  
A. Svintsitskyi ◽  
O. Synenkyi
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Antinuclear Antibodies ◽  
Clinical Laboratory ◽  
Statistical Significance ◽  
Diagnostic Value ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
Neurologic Disorders

The criteria for the classification of systemic lupus erythematosus were proposed in 1971 by the American College of Rheumatology. They have been clarified since then, but need to be revised.Objective. To determine the diagnostic value of the criteria for the classification of systemic lupus erythematosus proposed by the American College of Rheumatology.Materials and methods. 370 patients (331 women (89.46%) and 39 men (10.54%), average age 41.24 ± 0.63 years) with SLE and 234 patients (150 women (64.10%) and 84 men (35.90%), average age 48.82 ± 0.85 years) with other rheumatic diseases (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) were randomly enrolled into the study. The patients had undergone comprehensive clinical-laboratory and instrumental examinations in 2010–2018 before they received treatment. The analysis was conducted in MS Excel and SPSS by constructing contingency tables and calculating indicators of diagnostic value.Results. We identified the following criteria as those that can with statistical significance predict the presence of systemic lupus erythematosus: butterfly rash, photosensitivity, serositis (pleuritis, pericarditis), neurologic disorders (seizures, psychosis), thrombocytopenia, renal disorders (proteinuria, cylindruria), anti-dsDNA and antinuclear antibodies.

scholarly journals THU0269 CLINICAL COMPARISON OF NEW CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS IN A COLOMBIAN COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 361.2-361
Author(s):  
S. Herrera ◽  
J. C. Diaz-Coronado ◽  
D. Hernandez-Parra ◽  
Y. Durango-Durango ◽  
C. Perez-Rios ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
False Negative ◽  
Classification Criteria ◽  
Disease Classification ◽  
Systemic Lupus ◽  
Clinical Criteria ◽  
American College Of Rheumatology ◽  
Clinical Records ◽  
New Criteria

Background:Due to heterogeneity of the disease, there has been several classification criteria for Systemic Lupus Erythematosus (SLE). These have considered the knowledge obtained through the years and have strived for increased sensibility and specificity. Recently, both EULAR and ACR have proposed new criteria for disease classification that mandate a positive ANA result to apply the criteria.Objectives:To compare the 2019 EULAR/ACR classification criteria (1) with the Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria (2) and the American College of Rheumatology (ACR) 1997 classification criteria in a Colombian cohort (3).Methods:A cross-section retrospective study was done with data collected between 2014 and 2018 from a population diagnosed with SLE by a group of rheumatology in an autoimmunity referral centre and followed for one year. The new 2019 EULAR/ACR classification criteria were applied to the information collected from the clinical records. Three sets of criteria were compared using Cohen´s kappa coefficient and concordance was evaluatedResults:We obtained information for 480 patients, in this analysis were mostly females (96%). Anti-nuclear antibody (ANA) results were available for 95% of the patients. According to SLICC classification criteria the diagnosis of SLE was definite in 92% of patients, 81% by ACR 1997 and 89% using ACR/EULAR 2019. The sensibility was 93% and 97% for ACR/EULAR 2019 and SLICC 2012, and the specificity was 67% and 48% respectively. The concordance analysis between the two sets of criteria showed agreement of 92% (kappa 0.52 p <0.001) in the whole group.Conclusion:We found good agreement between SLICC 2012 criteria and EULAR/ACR 2019 classification criteria. In contrast with previous studies, where the new criteria had a sensitivity of 96.1% and specificity of 93.4%, in our cohort the sensitivity was maintained in 93% but the specificity decreased to 67%. A possible explanation could be the ANA negativity that was seen in 5% of the patients and would force to discard patients with false negative results. Despite this, the agreement of the criteria is good and should continue to be applied in our population, without abandoning the expert’s clinical criteria.References:[1]Aringer M, Costenbader K, Daikh D, et al. 2019 European League against Rheumatism/American College of rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis2019;78:1151–9[2]Petri M, Orbai A-M, Alarcón GS, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum2012;64:2677–86.[3]Hochberg MC. Updating the American College of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1997;40:1725.Disclosure of Interests:Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Deicy Hernandez-Parra: None declared, Yecenia Durango-Durango: None declared, Carolina Perez-Rios: None declared, Marcela Posada-Velásquez: None declared, Jennifer Rojas-Londoño: None declared, Manuela Vallejo-Patiño: None declared, Katherine Marín: None declared, Carlos Guerrero-Calderón: None declared, Sara jaramillo: None declared, Veronica Usuga-Graciano: None declared, Martha Isabel López-Flórez: None declared, Camilo Restrepo-Raigosa: None declared, Juan Pablo Restrepo-Hincapié: None declared, Catalina Carvajal-Naranjo: None declared, Sarita Restrepo-Upegui: None declared, Ricardo Pineda.Tamayo: None declared

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