PReS-FINAL-2356: A comparison of the American college of rheumatology and the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus using data from the uk juvenile systemic lupus erythematosus cohort study

Abstract Background Juvenile systemic lupus erythematosus is a multisystem inflammatory autoimmune disease affecting patients under 16 years old. Diagnosis may be difficult because of the large clinical heterogeneity. Classification criteria are important to ensure a clear definition and consistent inclusion of patients in clinical trials. The objective of the work: is to Compare the performance of the classification criteria of the American College of Rheumatology (ACR 1997), those of the Systemic Lupus International Collaborating Clinics (SLICC 2012) and the new classification criteria together with the European League Against Rheumatism “EULAR” and the American College of Rheumatology “ACR” (EULAR/ACR 2019). Methods This is a cross-sectional retrospective study carried out in a tertiary care service over a period of one year, from January 1, 2020 to December 31, 2020. The patients were subjected to the different classification criteria ACR 1997, SLICC 2012 and EULAR/ACR 2019. All our patients were matched in age and sex with control cases followed for inflammatory disease (12 control cases). Results Six patients were diagnosed with juvenile systemic lupus erythematosus (JSL) over the period of our study. A clear predominance of women was noted with a sex ratio of 5 girls/1 boy. The mean age at the time of diagnosis was 9 years (extremes: 3 –12 years). The diagnosis was made after an average delay of 5 months (extremes: 1–12 months). All of our patients met the three classification criteria. Sensitivity to all criteria was noted at diagnosis and during the first months of follow-up with higher sensitivity for SLICC criteria. Regarding the control cases, 3 patients met the ACR 1997 criteria. Conclusion In this population of Juvenile systemic lupus erythematosus, the SLICC criteria gave the best results in terms of sensitivity and precision at the time of diagnosis and during the first months of follow-up, while the ACR 1997 criteria were less specific.

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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-analysis

Autoimmunity Reviews ◽

10.1016/j.autrev.2018.01.007 ◽

2018 ◽

Vol 17 (3) ◽

pp. 316-322 ◽

Cited By ~ 24

Author(s):

Esther A.R. Hartman ◽

Annet van Royen-Kerkhof ◽

Johannes W.G. Jacobs ◽

Paco M.J. Welsing ◽

Ruth D.E. Fritsch-Stork

Keyword(s):

Systematic Review ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Meta Analysis ◽

Classification Criteria ◽

Systemic Lupus ◽

Juvenile Systemic Lupus Erythematosus ◽

American College Of Rheumatology

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1675 Real world treatment of juvenile systemic lupus erythematosus (JSLE): evidence from the UK JSLE cohort study

10.1136/archdischild-2021-rcpch.790 ◽

2021 ◽

Author(s):

Naomi Egbivwie ◽

Andrea L Jorgensen ◽

Michael W Beresford ◽

Christian M Hedrich ◽

Eve MD Smith ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cohort Study ◽

Real World ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Juvenile Systemic Lupus Erythematosus ◽

The Uk

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Juvenile systemic lupus erythematosus: neurological involvement

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1997000400016 ◽

1997 ◽

Vol 55 (3B) ◽

pp. 606-609 ◽

Cited By ~ 6

Author(s):

Katia M.R.S. Schmutzler ◽

Luiz Celso P. Vilanova ◽

José Geraldo C. Lima ◽

Maria Odete Hilário ◽

Charles K. Naspitz

Keyword(s):

Systemic Lupus Erythematosus ◽

Cerebrospinal Fluid ◽

Lupus Erythematosus ◽

Classification Criteria ◽

Neurological Involvement ◽

Systemic Lupus ◽

Juvenile Systemic Lupus Erythematosus ◽

Extrapyramidal Syndrome ◽

American College Of Rheumatology ◽

Pyramidal Syndrome

With the purpose of analyzing the neurological involvement due to systemic lupus erythematosus (SLE), we evaluated 17 female patients who were seen regularly at the hospital and had been diagnosed as having SLE according to classification criteria proposed by the American College of Rheumatology revised in 1982, before the age of 16. Neurological involvement was detected in 12 patients (71%): headache (35%), extrapyramidal syndrome (35%), epileptic syndrome (24%) pyramidal syndrome (24%), peripheral neuropathy (12%) and optic neuritis (6%). The findings of CT scan (58%) and cerebrospinal fluid (50%) were most closely correlated to clinical neurological involvement.

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European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) SLE classification criteria item performance

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-219373 ◽

2021 ◽

pp. annrheumdis-2020-219373

Author(s):

Martin Aringer ◽

Ralph Brinks ◽

Thomas Dörner ◽

David Daikh ◽

Marta Mosca ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Metabolic Diseases ◽

Classification Criteria ◽

Joint Involvement ◽

Systemic Lupus ◽

Entry Criterion ◽

American College Of Rheumatology ◽

European League Against Rheumatism ◽

European League

Background/objectivesThe European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 classification criteria for systemic lupus erythematosus system showed high specificity, while attaining also high sensitivity. We hereby analysed the performance of the individual criteria items and their contribution to the overall performance of the criteria.MethodsWe combined the EULAR/ACR derivation and validation cohorts for a total of 1197 systemic lupus erythematosus (SLE) and n=1074 non-SLE patients with a variety of conditions mimicking SLE, such as other autoimmune diseases, and calculated the sensitivity and specificity for antinuclear antibodies (ANA) and the 23 specific criteria items. We also tested performance omitting the EULAR/ACR criteria attribution rule, which defines that items are only counted if not more likely explained by a cause other than SLE.ResultsPositive ANA, the new entry criterion, was 99.5% sensitive, but only 19.4% specific, against a non-SLE population that included other inflammatory rheumatic, infectious, malignant and metabolic diseases. The specific criteria items were highly variable in sensitivity (from 0.42% for delirium and 1.84% for psychosis to 75.6% for antibodies to double-stranded DNA), but their specificity was uniformly high, with low C3 or C4 (83.0%) and leucopenia <4.000/mm³ (83.8%) at the lowest end. Unexplained fever was 95.3% specific in this cohort. Applying the attribution rule improved specificity, particularly for joint involvement.ConclusionsChanging the position of the highly sensitive, non-specific ANA to an entry criterion and the attribution rule resulted in a specificity of >80% for all items, explaining the higher overall specificity of the criteria set.

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

The Journal of Rheumatology ◽

10.3899/jrheum.180478 ◽

2018 ◽

Vol 46 (7) ◽

pp. 721-726 ◽

Cited By ~ 21

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.

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PARTICULARITIES OF PEDIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS – LITERATURE REVIEW

Romanian Journal of Rheumatology ◽

10.37897/rjr.2017.1.1 ◽

2017 ◽

Vol 26 (1) ◽

pp. 5-7

Author(s):

Oana-Maria Farkas ◽

◽

Sigrid Covaci ◽

Alexis-Virgil Cochino ◽

◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Pediatric Population ◽

Signs And Symptoms ◽

Classification Criteria ◽

Neurological Involvement ◽

Systemic Lupus ◽

Pediatric Systemic Lupus Erythematosus ◽

American College Of Rheumatology ◽

Clinical Onset

Pediatric Systemic Lupus Erythematosus (pSLE) is a complex autoimmune disease with onset of symptoms before 18 years of age, accounting for 18-20% of all SLE cases. Although the American College of Rheumatology (ACR) classification criteria and the SLICC (Systemic Lupus International Collaborating Clinics) classification criteria for adults with SLE are commonly applied to pSLE, its clinical onset is different. Renal and neurological involvement tend to be more common and more severe in pediatric population as compared to adults, being therefore major determinants of prognosis and mortality. Renal biopsy should be performed as early as possible in every case of pSLE with signs and symptoms of renal impairment.

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