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Thread: Possibly new ACR SLE classification criteria

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    Lightbulb Possibly new ACR SLE classification criteria

    Hello,

    Has anyone heard anything about the possible new revision of the ACR (American College of Rheumatology) Classification for SLE? I was searching online and came across an abstract from the 2009 annual scientific meeting. Michelle Petri performing some research looking to change the criteria to better reflect the multi-organ involvement and not just the skin involvement so much. Here is what the new classification would involve:


    The 2009 ACR/ARHP Annual Scientific Meeting
    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

    Anyways it seems like more people would be able to fit this criteria and be diagnosed earlier because the immunological tests have more weight here. Let me know if anyone has any info about how this is progressing or has any thoughts.

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    My liver specialist thinks I have Lupus. All the tests point to it. My problem was spotted on a blood test panel for my diabetes. My liver enzymes were high. At first he thought I had cirrhosis of the liver. I do not have much arithitis, but my bones actually ache. I had the classic rash that would flare up for years, but thought it was an allergy and never mentioned it to my doctor. I also had all the other symptoms on the sticky posts. I have liver damage, but do not know the extent yet. I am scheduled for an ultrasound on the liver and depending on that a biopsy of the liver. He put me on a tapering dose of predisone for three weeks. Most of the symptoms went away for two months. He scheduled me for an appointment with an Ra which is hard to get in this area. It will be ion April 24th. Then he thinks I will be put on a low dose of predisone daily. Until the Ra confirms his diagnosis , he will not do that. He thinks I have systemic lupus. Since I do not have the aritiis symptoms, why does an Ra have to confirm it?

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    Quote Originally Posted by hobbsey View Post
    My liver specialist thinks I have Lupus. All the tests point to it. My problem was spotted on a blood test panel for my diabetes. My liver enzymes were high. At first he thought I had cirrhosis of the liver. I do not have much arithitis, but my bones actually ache. I had the classic rash that would flare up for years, but thought it was an allergy and never mentioned it to my doctor. I also had all the other symptoms on the sticky posts. I have liver damage, but do not know the extent yet. I am scheduled for an ultrasound on the liver and depending on that a biopsy of the liver. He put me on a tapering dose of predisone for three weeks. Most of the symptoms went away for two months. He scheduled me for an appointment with an Ra which is hard to get in this area. It will be ion April 24th. Then he thinks I will be put on a low dose of predisone daily. Until the Ra confirms his diagnosis , he will not do that. He thinks I have systemic lupus. Since I do not have the aritiis symptoms, why does an Ra have to confirm it?
    Lupus is considered an Arthritic Disease so when it is suspected we are sent to a Rhuematologist for treatment. Hope this answers your questions
    Mari

    Success is not final, failure is not fatal: it is the courage to continue that counts.

    ~Winston Churchill~







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