Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


SLICC Revision of the ACR Classification Criteria for SLE

Petri,  Michelle, Systemic Lupus International Collaborating Clinic (SLICC),  

Purpose:

The ACR Classification Criteria for SLE date from 1982 with a 1997 revision that was not validated. Because of new knowledge of autoantibodies, neuropsychiatric lupus, the importance of low complement and the need for lupus nephritis to be a "stand alone" criterion, the SLICC group undertook a revision.

Method:

An initial set of relevant variables was determined. Real patient scenarios (n=716) of SLE and non-SLE controls were submitted by SLICC centers. A consensus diagnosis was arrived at for each scenario. The consensus diagnoses were used to identify the variables that were most predictive of SLE. Recursive partitioning was employed to derive a classification rule based on multiple candidates predictor variables. This preliminary classification rule was discussed at three SLICC meetings, independently validated by a SLICC steering comittee and further refined.

Results:

Classify a patient as having SLE if: The patient has biopsy-proven lupus nephritis with ANA or anti-dsDNA OR the patient satisfies four of the criteria, including at least one clinical and one immunologic criterion.

Clinical Criteria

1. Acute or subacute cutaneous lupus

2. Chronic cutaneous lupus

3. Oral/Nasal ulcers

4. Nonscarring alopecia

5. Inflammatory synovitis with physician-observed swelling of two or more joints OR tender joints with morning stiffness

6. Serositis

7. Renal: Urine protein/creatinine (or 24 hr urine protein) representing at least 500 mg of protein/24 hr or red blood cell casts

8. Neurologic: seizures, psychosis, mononeuritis multiplex, myelitis, peripheral or cranial neuropathy, cerebritis (acute confusional state)

9. Hemolytic anemia

10. Leukopenia (<4000/mm3 at least once)

OR

Lymphopenia (<1000/mm3 at least once)

11. Thrombocytopenia (<100,000/mm3) at least once

Immunologic Criteria

1. ANA above laboratory reference range

2. Anti-dsDNA above laboratory reference range (except ELISA: twice above laboratory reference range)

3. Anti-Sm

4. Antiphospholipid antibody

lupus anticoagulant

false-positive test for syphilis

anticardiolipin–at least twice normal or medium-high titer

anti-b2 glycoprotein 1

5. Low complement

low C3

low C4

low CH50

6. Direct Coombs test in absence of hemolytic anemia

When applied to our patient scenarios, this classification rule had better sensitivity than the ACR 11 (94% vs. 86%), and roughly equal specificity (92% vs. 93%), and resulted in significantly fewer misclassifications (p=.0082).

Conclusion:

The SLICC SLE classification criteria address the major deficiencies of the ACR. Currently, ongoing validation will determine if they perform better than the ACR criteria.

To cite this abstract, please use the following information:
Petri, Michelle, Systemic Lupus International Collaborating Clinic (SLICC), ; SLICC Revision of the ACR Classification Criteria for SLE [abstract]. Arthritis Rheum 2009;60 Suppl 10 :895
DOI: 10.1002/art.25975

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