BY SARA FREEMAN
The first EULAR and American Col-
lege of Rheumatology joint criteria
for classifying systemic lupus ery-
thematosus have a sensitivity and
a specificity of more than 90%.
This is important because they
improve upon the existing ACR
and Systemic Lupus International
Collaborating Clinics (SLICC) crite-
ria, said Prof. Martin Aringer, who
cochaired the Steering Committee
that produced the new classifica-
SLE classification criteria perform well in
VIDEO HIGHLIGHTS: Click here to watch a video interview with Prof. Thomas Dörner, professor of
medicine at Charité–Universitätsmedizin Berlin and codeveloper of the guidelines.
non-SLE cause can be discounted.
Fever has recently been identified
as a marker of early-stage SLE in at
least some patients, and its addition
to the classification criteria “adds
a new dimension to how we think
about the disease and allows us to
distinguish early disease from mimicking diseases,” she explained. At
the other end of the classification
spectrum, a finding of class III or IV
lupus nephritis on renal biopsy receives 10 points, and hence, this one
finding plus having a high enough
level of ANA leads to SLE classification regardless of whether the
patient has any other signs or symptoms of the disease.
That’s because “85% of our ex-
perts said that they would feel
confident classifying a patient as
having lupus based only on a re-
nal biopsy” and ANA positivity,
said Dr. Johnson, who served as
the ACR-appointed cochair of the
criteria-writing panel along with a
cochair selected by EULAR, Prof.
Martin Aringer, professor of medicine and chief of the division of
rheumatology at the Technical University of Dresden (Germany). She
cautioned that other levels of lupus
nephritis, class II or V, confer only
8 points to the classification and so
by themselves are not enough to
label a person as having lupus.
During her presentation, Dr. John-
son cited the high levels of sensi-
tivity and specificity that the new
classification criteria demonstrated
in a validation cohort of more than
1,000 cases and controls. In the
validation analysis, the new crite-
ria had a sensitivity of 96.12% and
specificity of 94.43% for classifying
SLE, giving the new criteria a better
result on both these measures than
either the 1997 ACR criteria (Arthritis
Rheum. 1997 Sept; 40[ 9]:1725) or the
2012 Systemic Lupus International
Collaborating Clinics criteria (Arthri-
tis Rheum. 2012 Aug;64[ 8]:2677-86).
The 22 criteria cluster into seven
separate clinical domains and three
different immunologic domains
(see chart). The point values assigned to each criterion range from
2 to 10 points.
Dr. Johnson had no disclosures.
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