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Alasmari A, Aldakhil H, Almutairi A, Nashawi M, Basahl E, Abushhaiwia A, Hashad S, Etayari H, Elfawires Y, Khawaja KW, Bakry R, Akbar L, De Vol E, AlSaleem A, Al-Mayouf SM. Utility of pan-immune-inflammation value as a predictor of the prognosis of childhood lupus. Lupus 2024:9612033241275227. [PMID: 39150262 DOI: 10.1177/09612033241275227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic inflammatory multisystemic disease. Monitoring disease activity thoughtout the disease course is important for effective management and assessment of disease outcome. OBJECTIVE To assess whether the pan-immune inflammation value (PIIV) at diagnosis could predict organ involvement and disease activity in childhood SLE (cSLE) patients after 12 months of disease onst. METHODS This is an observational retrospective multicenter study that comprised cSLE patients seen and followed at the participating centers between January 2010 and December 2022. All patients met the EULAR/ACR-19 criteria, were immunosuppressive drug-naïve at the time of SLE diagnosis and had a minimal follow-up period of 12 months. The data included clinical and laboratory findings and disease activity using the SLEDAI-2K. Receiver operating characteristic (ROC) curves were employed to determine the optimal cut-off value of PIIV and assess its predictive potential for disease activity, and organ involvement. RESULTS A total of 125 patients (104 female) with a median age of 16.0 (IQR 5.6) years, a median age at disease onset of 10.9 (IQR 3.0) years, and a median disease duration of 4.8 (IQR 5.3) years were included. The most frequent involved organs at diagnosis were hematological (89.6%), musculoskeletal (68.8%), mucocutaneous (63.2%), and renal (58.4%). However, at a 12-month follow-up visit, the most frequent involved organs were renal (40.0%), hematological (39.2%), musculoskeletal (15.2%), and mucocutaneous (10.4%). The median PIIV at diagnosis was 139 (IQR 229.6), while the median SLEDAI was 12 (IQR 6.5) and 3.5 (IQR 7.0) at diagnosis and 12 months, respectively. An optimal PIIV cut-off of 250 was found to be a predicative for disease activity, with a sensitivity of 45% and a specificity of 86%. The study revealed that the PIIV successfully predicted four systems in our cohort of patients. CONCLUSION Our work suggests the PIIV might be a reasonable predictor for organ involvement and disease activity in newly diagnosed cSLE, though further research, particularly larger studies, is required to validate these findings, especially regarding organ involvement.
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Affiliation(s)
- Ali Alasmari
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Haifa Aldakhil
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulaziz Almutairi
- Department of Pediatric Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohammed Nashawi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Emtenan Basahl
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Soad Hashad
- Pediatric Rheumatology, Tripoli Children Hospital, Tripoli, Libya
| | - Hala Etayari
- Pediatric Rheumatology, Tripoli Children Hospital, Tripoli, Libya
| | - Yusra Elfawires
- Pediatric Rheumatology, Tripoli Children Hospital, Tripoli, Libya
| | - Khulood Walid Khawaja
- Pediatric Rheumatology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Reima Bakry
- Department of Pediatric, Maternity and Children Specialized Hospital, Jeddah, Saudi Arabia
| | - Lujayn Akbar
- Department of Pediatrics, King Fahad University Hospital, Khobar, Saudi Arabia
| | - Edward De Vol
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alhanouf AlSaleem
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sulaiman M Al-Mayouf
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Peyronel F, Rossi GM, Palazzini G, Odone L, Errichiello C, Emmi G, Vaglio A. Early-onset lupus nephritis. Clin Kidney J 2024; 17:sfae212. [PMID: 39135943 PMCID: PMC11318049 DOI: 10.1093/ckj/sfae212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Indexed: 08/15/2024] Open
Abstract
Early-onset systemic lupus erythematous (SLE) is a distinct clinical entity characterized by the onset of disease manifestations during childhood. Despite some similarities to patients who are diagnosed during adulthood, early-onset SLE typically displays a greater disease severity, with aggressive multiorgan involvement, lower responsiveness to classical therapies, and more frequent flares. Lupus nephritis is one of the most severe complications of SLE and represents a major risk factor for long-term morbidity and mortality, especially in children. This review focuses on the clinical and histological aspects of early-onset lupus nephritis, aiming at highlighting relevant differences with adult patients, emphasizing long-term outcomes and discussing the management of long-term complications. We also discuss monogenic lupus, a spectrum of conditions caused by single gene variants affecting the complement cascade, extracellular and intracellular nucleic acid sensing and processing, and occasionally other metabolic pathways. These monogenic forms typically develop early in life and often have clinical manifestations that resemble sporadic SLE, whereas their response to standard treatments is poor.
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Affiliation(s)
- Francesco Peyronel
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanni M Rossi
- Nephrology Unit, Parma University Hospital, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Laboratorio di Immunopatologia Renale “Luigi Migone”, University of Parma, Parma, Italy
| | - Giulia Palazzini
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Ludovica Odone
- Nephrology and Dialysis Unit, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Carmela Errichiello
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giacomo Emmi
- Department of Medical, Surgery and Health Sciences, University of Trieste, Italy
- Clinical Medicine and Rheumatology Unit, Cattinara University Hospital, Trieste, Italy
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Melbourne, Australia
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
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Patrizi ST, Tandel MD, Boothroyd D, Simard JF, Hsu JJ. Prognostic Value of the 2019 EULAR/American College of Rheumatology Systemic Lupus Erythematosus Classification Criteria to Renal Response One Year After Treatment in a Cohort With Childhood-Onset Lupus Nephritis. ACR Open Rheumatol 2024; 6:454-462. [PMID: 38695166 PMCID: PMC11319914 DOI: 10.1002/acr2.11674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE In 2019, the EULAR/American College of Rheumatology developed classification criteria for systemic lupus erythematosus (SLE). A positive correlation between summary score at diagnosis and SLE disease activity at five years has been noted in adult patients with lupus, but little is known among the pediatric population. We evaluated the prognostic value of higher summary scores and number of extrarenal domains at diagnosis (low/moderate number [1-5] vs high number [6-9]) to renal outcomes after one year of treatment in pediatric patients with lupus nephritis (LN). METHODS This retrospective, single-center cohort study included 74 pediatric patients with LN. Published pediatric renal response definitions were used for our outcome measure (no, partial, and complete response). Descriptive statistics were reported, and an ordinal logistic regression estimated adjusted odds ratios (ORs) for renal response including 95% confidence intervals (CIs). RESULTS Patients with high extrarenal domains had OR 1.47 (95% CI 0.55-2.91) of having a complete renal response compared to patients with low/moderate domains. Patients with a summary score <30 had OR 1.31 (95% CI 0.50-3.44) of having a complete renal response relative to a summary score ≥30, though a larger proportion of patients with a summary score of ≥30 had no renal response after one year of treatment. CONCLUSION More extrarenal domains at diagnosis did not have a statistically significant impact on renal response at one year, nor did a higher summary score. However, a larger portion of patients with a summary score <30 achieved complete renal response compared to patients with a score ≥30.
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Affiliation(s)
| | | | | | | | - Joyce J. Hsu
- Stanford Medicine Children's HealthPalo AltoCalifornia
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Al-Mayouf SM, Hamad A, Kaidali W, Alhuthil R, Alsaleem A. Clinical characteristics and prognostic value of autoantibody profile in children with monogenic lupus. JOURNAL OF RHEUMATIC DISEASES 2024; 31:143-150. [PMID: 38957362 PMCID: PMC11215254 DOI: 10.4078/jrd.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/21/2023] [Accepted: 12/04/2023] [Indexed: 07/04/2024]
Abstract
Objective To report the frequency of selected autoantibodies and their associations with clinical features in Arab children with monogenic lupus. Methods This study was retrospective single-center study of genetically confirmed monogenic lupus cases at childhood lupus clinic at King Faisal Specialist Hospital and Research Center, from June 1997 to July 2022. We excluded familial lupus without genetic testing and patients with insufficient data. Collected data comprised clinical and laboratory findings, including the autoantibody profile, which included the anti-double-stranded DNA (anti-dsDNA), anti-Smith, anti-Sjögren's-syndrome-related antigen A (anti-SSA), anti-Sjögren's-syndrome-related antigen B (anti-SSB), and antiphospholipid (APL) antibodies. Also, disease activity and accrual disease damage were collected at the last follow-up visit. Results This study enrolled 27 Arab patients (14 males) with a median age of 11 years (interquartile range 8.0~16 years), with 63% having early-onset disease. The consanguinity rate and family history of lupus were high (74.1% and 55.6%, respectively). The most frequent clinical features were hematological (96.3%), fever (81.5%), mucocutaneous lesions (85.2%), and renal (66.7%). The frequency of the APL antibodies was 59.3%, anti-dsDNA was 55.6%, and anti-Smith and anti-SSA were 48.2% and 44.4%, respectively. Moreover, dsDNA antibodies were significantly associated with musculoskeletal complaints (p<0.05). Likewise, both anti-Smith and anti-SSA antibodies were linked to failure to thrive and recurrent infections in the univariate analysis (p<0.05). Conclusion Our study reveals autoantibody frequencies and their association with clinical and prognostic in a substantial monogenic lupus cohort. Distinct clinical manifestations and prognosis association with certain autoantibodies support the idea that monogenic lupus is a distinctive form of lupus. Larger studies needed to validate these findings.
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Affiliation(s)
- Sulaiman M Al-Mayouf
- Depatrment of Pedaitric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Pediatrics, Alfaisal University, Riyadh, Saudi Arabia
| | - Alaa Hamad
- Department of Pediatrics, Alfaisal University, Riyadh, Saudi Arabia
| | - Wassima Kaidali
- Department of Pediatrics, Alfaisal University, Riyadh, Saudi Arabia
| | - Raghad Alhuthil
- Depatrment of Pedaitric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Alhanouf Alsaleem
- Depatrment of Pedaitric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Babgi E, Al Marri M, Al-Mayouf SM, Shehata R, Majeed M, Alsufyani K, Batouk E, Bakri R, AlE'ed A, Yateem M, Akbar L, Gari S, Alghamdi W, Asiri A, Al Rowais A. Comparison of systemic lupus international collaborating clinics 2012 classification criteria and European league against rheumatism/American college of rheumatology 2019 classification criteria for early detection of childhood onset systemic lupus erythematosus (multi-center study). Lupus 2024; 33:629-637. [PMID: 38533912 DOI: 10.1177/09612033241240830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To assess the performance of the new EULAR/ACR criteria, particularly for early detection of cSLE, in comparison to the SLICC criteria among the pediatric population in multiple centers in Saudi Arabia. METHODS We conducted a retrospective study that enrolled pediatric patients up to the age of 14 years who've been diagnosed with SLE and followed in pediatric rheumatology clinics at 9 multi-tertiary hospitals in Saudi Arabia from 2010 to 2021 as a case group and were compared to a similar group of pediatric patients who've had defined rheumatological diseases other than SLE with a positive ANA titer (≥1:80) as controls. In total, 245 patients were included and distributed as 129 cases (diagnosed by expert pediatric rheumatologists) versus 116 patients in the control group. All relevant clinical information, including history, physical examination findings, and laboratory tests, was documented at the initial presentations. Then, the two sets of SLE classification criteria were applied to both groups to define who's going to meet both or either one of them. The exclusion criteria included those who had insufficient data or had overlapping or undifferentiated diseases. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating curve (ROC), and accuracy were calculated for SLICC 2012 and EULAR/ACR 2019 criteria (total scores≥ 10 and ≥ 13). We performed a Chi-squared test to compare sensitivity and specificity of SLICC 2012 and EULAR/ACR 2019. RESULTS For SLICC (cut-off ≥4 criteria), the sensitivity was found to be 96.9% (95% CI 92.6%-99.4%) and the specificity was 94.8% (95% CI 89.6%-98.32%), with PPV and NPV of 95.4% and 96.5%, respectively. The ROC for it was 0.96 (95% CI 0.93-0.99), and this criterion had an accuracy of 95%. Regarding EULAR/ACR (total score ≥ 10), the performance measure showed a sensitivity of 99.2% and a specificity of 86.2%. Similarly, PPV was 88.9%; while NPV was a little higher (99.0%) than SLICC. The ROC for EULAR/ACR (total score ≥ 10) was 0.93 (95% CI 0.89-0.96), and this criterion had an accuracy of 93%. However, there was no statistically significant difference between the sensitivity and specificity of either using SLICC or EULAR/ACR (total score ≥ 10), as reflected by a p-value of 0.86 using the Chi-squared test. Although applying the EULAR/ACR with a total score of ≥ 13 revealed lower sensitivity (93.8%) than both the SLICC and the EULAR/ACR (total score ≥ 10), the specificity for it was found to increase up to 91.4% (85.7-96.2%) compared to the (86.2%) specificity of the EULAR/ACR (total score ≥ 10). CONCLUSION In this cohort among the Saudi population with childhood-onset SLE, the new EULAR/ACR 2019 criteria efficiently enable early detection of SLE, although a more frequent rate of false positives was observed with them. Escalating the total score from ≥ 10 to ≥ 13 in the cSLE population improved the specificity close to that of SLICC 2012. Further prospective studies in pediatrics need to be done for the validation of a cut- off score of ≥ 13 in cSLE rather than the traditional score of ≥ 10 in aSLE.
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Affiliation(s)
- Esraa Babgi
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Munira Al Marri
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sulaiman M Al-Mayouf
- Pediatric Rheumatology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Rawia Shehata
- Department of Pediatrics, King Abdulaziz Hospital, Jeddah, Saudi Arabia
| | - Mahmoud Majeed
- Department of Pediatrics, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Khayriah Alsufyani
- Department of Pediatrics, Maternity and Children Hospital, Makkah, Saudi Arabia
| | - Entesar Batouk
- Department of Pediatrics, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Reema Bakri
- Department of Pediatrics, East Jeddah Hospital, Jeddah, Saudi Arabia
| | - Ashwaq AlE'ed
- Department of Pediatrics, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Mada Yateem
- Department of Pediatrics, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Lujayn Akbar
- Pediatric Rheumatology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Shahad Gari
- Department of Pediatrics, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Wafa Alghamdi
- Department of Pediatrics, East Jeddah Hospital, Jeddah, Saudi Arabia
| | - Abdularahman Asiri
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Al Rowais
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Al-Mayouf SM, Alkhars F, AlSaleem A. Phenotype and disease course differences in monogenic and sporadic childhood lupus. Lupus 2023; 32:1548-1554. [PMID: 37878993 DOI: 10.1177/09612033231211065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To report the differences in phenotypic characteristics, disease course, and outcome in monogenic and sporadic childhood lupus (SC-lupus) from a single tertiary childhood lupus clinic. METHODS A descriptive, observational, cross-sectional study was conducted. Data were retrospectively collected at the last follow-up visit on patients with monogenic lupus proven by genetic variants and SC-lupus seen between June 1997 and July 2022. SC-lupus patients were selected by systematic sampling from lupus patients presenting to our lupus clinic; the first patient was chosen randomly, and the subsequent patients were chosen at intervals of three. Data comprised the clinical and laboratory findings, disease activity using the SLEDAI, and damage measured by the pSDI. RESULTS A total of 54 patients with a median disease duration of 6.8 (IQR 3.5-10.5) years were included. There were 27 patients with monogenic lupus and 27 patients with SC-lupus, with a median age at disease onset of 3.5 (IQR 1.0-6.0), and 9.5 (IQR 7.0-11.8), respectively. (p < 0.05). The rate of consanguinity and family history of lupus were higher in monogenic lupus patients. The two groups were comparable. However, monogenic lupus patients showed more gastrointestinal tract symptoms, and failure to thrive (p < 0.05). They also had more infections. The frequency of the autoantibody profile was higher in monogenic lupus patients. Belimumab was more frequently used in monogenic lupus while rituximab in SC-lupus patients. Monogenic lupus patients had a higher mean SLEDAI, but statistically, it was insignificant. Patients with monogenic lupus had greater disease damage, with a higher mean pSDI and a higher mortality rate (p < 0.05). CONCLUSION Patients with monogenic lupus are likely to have an early disease onset and a strong family history of lupus, as well as a guarded prognosis, which is likely due to the disease's severity and frequent infections. These differences may be related to the high consanguinity rate and underlying genetic variants.
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Affiliation(s)
- Sulaiman M Al-Mayouf
- Pediatric Rheumatology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fatima Alkhars
- Pediatric Rheumatology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Alhanouf AlSaleem
- Pediatric Rheumatology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Zhang L, Lu W, Yan D, Liu Z, Xue L. Systemic Lupus Erythematosus Risk Probability Index: ready for routine use? Results from a Chinese cohort. Lupus Sci Med 2023; 10:e000988. [PMID: 37696613 PMCID: PMC10496657 DOI: 10.1136/lupus-2023-000988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To evaluate the performance of Systemic Lupus Erythematosus Risk Probability Index (SLERPI) in patients with SLE using a Chinese cohort. METHODS The Chinese cohort included 352 patients with and 385 without SLE (control group). The clinical data of patients, including demographic data, clinical findings and serological profiles, were collected. Patients with an SLERPI score >7 were classified as SLE. The performance of the American College of Rheumatology (ACR)-1997, Systemic Lupus International Collaborating Clinics (SLICC)-2012 and European League Against Rheumatism (EULAR)/ACR-2019 criteria were used as references. RESULTS Of these four classification criteria, SLERPI has the highest sensitivity (98.3% (95% CI 96.3% to 99.4%)), but lowest specificity (89.4% (95% CI 85.8% to 92.2%)). In the control group, patients eligible for the classification criteria for SLE were mainly those with primary Sjogren's syndrome (pSS) and undifferentiated connective tissue disease (UCTD), which adversely affected the specificity of the classification criteria. Moreover, significantly more patients with pSS and UCTD met SLERPI than those who met other classification criteria. After excluding patients with pSS and UCTD from the control group, the specificity and accuracy of SLERPI improved to 94.3% (95% CI 91.0% to 96.6%) and 96.5% (95% CI 95.0% to 97.9%), respectively, and both outperformed the EULAR/ACR-2019 criteria. The time to SLERPI classification was the same as their clinical time to diagnosis in 261 patients, earlier than the clinical diagnosis in 23 patients and later than the clinical diagnosis in 9 patients. A total of 280 patients had the same time to SLERPI classification as EULAR/ACR-2019, 8 patients had earlier than EULAR/ACR-2019 and 1 patient had later than EULAR/ACR-2019. CONCLUSION SLERPI performed well in patients with SLE, particularly for the earlier diagnosis of SLE.
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Affiliation(s)
- Lin Zhang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wentian Lu
- Department of Hematology, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Dong Yan
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhichun Liu
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Leixi Xue
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Cetin N, Acikalin MF, Tufan AK, Kasifoglu N. The value of 2019 EULAR/ACR classification criteria in predicting lupus nephritis in childhood-onset systemic lupus erythematosus. KLINISCHE PADIATRIE 2023; 235:277-283. [PMID: 36990435 DOI: 10.1055/a-1970-6301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND We investigated the role of European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for the prediction of LN among children with SLE. METHODS The data of the patients with childhood-onset SLE diagnosed based on 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria were retrospectively evaluated. Based on 2019 EULAR/ACR classification criteria, the scoring was done at the time of renal biopsy. RESULTS Fifty-two patients (12 with LN, 40 without LN) were included. The mean score was higher in patients with LN than those without (30.8±6.14, 19.8±7.76, respectively, p=0.000). The score value had indicative value for LN (area under curve [AUC]:0.863±0.055, cut-off value:22.5, p=0.000). Lymphocyte counts had a predictive value for LN (cut-off value:905/mm3, AUC:0.688±0.087, p=0.042). The score was positively associated with SLE disease activity index (SLEDAI) and activity index (r=0.879, p=0.000; r=0.811, p=0.001, respectively). There were significant negative associations between score value and GFR (r=-0.582, p=0.047). The patients with renal flare had higher the mean score than those of without renal flare (35±2/25.4±5.57, respectively, p=0.019). CONCLUSIONS The EULAR/ACR criteria score could reflect the activity of disease and severity of nephritis in childhood-onset SLE. A point of 22.5 as score value might be an indicator for LN. During scoring, it should be taken into account that lymphopenia might guide the prediction of LN.
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Affiliation(s)
- Nuran Cetin
- Department of Pediatric Nephrology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mustafa Fuat Acikalin
- Department of Pathology, Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Eskisehir, Turkey
| | - Asli Kavaz Tufan
- Department of Pediatric Nephrology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Nilgun Kasifoglu
- Medical Microbiology, Eskisehir Osmangazi Universitesi Tip Fakultesi, Eskisehir, Turkey
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Cody EM, Wilson BE, Ogbu EA, Huggins JL, Chen C, Qiu T, Ting TV, Flores F, Huang B, Brunner HI. Usefulness of the lupus low disease activity state as a treatment target in childhood-onset SLE. Lupus Sci Med 2023; 10:e000884. [PMID: 37253553 PMCID: PMC10230998 DOI: 10.1136/lupus-2022-000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Treat-to-target (T2T) strategies are advocated to improve prognosis in childhood-onset SLE (cSLE). Proposed T2T states include SLEDAI score of <4 (SLEDAI-LD), limited corticosteroid use (low-CS), and lupus low disease activity state (LLDAS). We sought to compare T2T states for their association with cSLE prognosis under consideration of relevant disease characteristics such as pre-existing damage, race and lupus nephritis (LN). METHODS Longitudinal data from 165 patients enrolled in the Cincinnati Lupus Registry were included. LN presence was based on renal biopsy, and patients were followed up until 18 years of age. RESULTS The 165 patients (LN: 45, white: 95) entered the registry within a median of 0 (IQR: 0-1) year post diagnosis and were followed up for a median of 4 (IQR: 2-5) years during which 80%, 92% and 94% achieved LLDAS, low-CS and SLEDAI-LD. Patients with LN were significantly less likely to achieve any T2T state (all p<0.03) and required a significantly longer time to reach them (all p<0.0001). Over the study period, patients maintained low-CS, SLEDAI-LD or LLDAS for a median of 76% (IQR: 48%-100%), 86% (IQR: 55%-100%) or 39% (IQR: 13%-64%) of their follow-up. Significant predictors of failure to maintain LLDAS included LN (p≤0.0062), pre-existing damage (p≤0.0271) and non-white race (p≤0.0013). There were 22%, 20% and 13% of patients who reached SLEDAI-LD, CS-low and LLDAS and nonetheless acquired new damage. Patients with LN had a higher risk of new damage than patients without LN even if achieving low-CS (p=0.009) or LLDAS (p=0.04). CONCLUSIONS Patients with LN and pre-existing damage are at higher risk of increased future damage acquisition, even if achieving a T2T state such as LLDAS. Among proposed common T2T states, the LLDAS is the hardest to achieve and maintain. The LLDAS may be considered the preferred T2T measure as it conveys the highest protection from acquiring additional disease damage.
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Affiliation(s)
- Ellen M Cody
- Pediatrics, Division of Nephrology, Hypertension and Pheresis, Washington University in St Louis, St Louis, Missouri, USA
| | - Bridget E Wilson
- Pediatrics, Cincinnati Children's Hospital Medical Center Burnet Campus, Cincinnati, Ohio, USA
| | - Ekemini A Ogbu
- Pediatrics, Division of Rheumatology, Cincinnati Children's Hospital Medical Center Burnet Campus, Cincinnati, Ohio, USA
- Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L Huggins
- Pediatrics, Division of Rheumatology, Cincinnati Children's Hospital Medical Center Burnet Campus, Cincinnati, Ohio, USA
| | - Chen Chen
- Pediatrics, Division of Epidemiology & Biostatistics, Cincinnati Children's Hospital Medical Center Burnet Campus, Cincinnati, Ohio, USA
| | - Tingting Qiu
- Pediatrics, Division of Epidemiology & Biostatistics, Cincinnati Children's Hospital Medical Center Burnet Campus, Cincinnati, Ohio, USA
| | - Tracy V Ting
- Pediatrics, Division of Rheumatology, Cincinnati Children's Hospital Medical Center Burnet Campus, Cincinnati, Ohio, USA
| | - Francisco Flores
- Pediatrics, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center Burnet Campus, Cincinnati, Ohio, USA
| | - Bin Huang
- Pediatrics, Division of Epidemiology & Biostatistics, Cincinnati Children's Hospital Medical Center Burnet Campus, Cincinnati, Ohio, USA
| | - Hermine I Brunner
- Pediatrics, Division of Rheumatology, Cincinnati Children's Hospital Medical Center Burnet Campus, Cincinnati, Ohio, USA
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Lerkvaleekul B, Chobchai P, Rattanasiri S, Vilaiyuk S. Evaluating performance of the 2019 EULAR/ACR, 2012 SLICC, and 1997 ACR criteria for classifying adult-onset and childhood-onset systemic lupus erythematosus: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1093213. [PMID: 36619627 PMCID: PMC9813386 DOI: 10.3389/fmed.2022.1093213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The American College of Rheumatology (ACR) 1997, Systemic Lupus International Collaborating Clinics (SLICC) 2012, and European League Against Rheumatism (EULAR)/ACR 2019 SLE criteria are often used to classify patients with adult-onset and childhood-onset systemic lupus erythematosus (SLE) in clinical practice because there are currently no diagnostic criteria for SLE. However, there is scarce evidence regarding which criteria are best for diagnosing patients with adult-onset and childhood-onset SLE. Methods We searched Medline and Scopus databases for English-language articles from inception through October 2021. Data were extracted from the included publications by two independent reviewers. We performed bivariate meta-analysis with a random-effects model to pool diagnostic parameters. Meta-regression and subgroup analyses were performed to explore heterogeneity sources. We used network meta-analysis to compare diagnosis performance among the three criteria and ranked them in descending order. Publication bias was assessed using Deeks' funnel plot. Results We included 29 studies for systematic review and meta-analysis. Of these, 18 studies involved adult-onset SLE and 11 studies involved childhood-onset SLE. The pooled sensitivities of the three criteria for diagnosis of adult-onset SLE were comparable between SLICC 2012 and EULAR/ACR 2019 [95.86, 95% confidence interval (CI) 92.28-97.81 vs. 94.79, 95% CI 92.03-96.63]; pooled specificity was highest in ACR 1997 (92.24, 95% CI 87.06-95.46). In childhood-onset SLE, pooled sensitivity was highest in SLICC 2012 (93.76, 95% CI 89.45-96.39), and pooled specificity was highest in ACR 1997 (95.89, 95% CI 91.73-98.00). In network meta-analysis, the pooled diagnostic odds ratio ranked highest for EULAR/ACR 2019 (131.570, 95% CI 61.50-281.47) in adult-onset SLE and ranked highest for SLICC 2012 (191.07, 95% CI 76.06-480.01) in childhood-onset SLE. Deeks' funnel plot showed no publication bias. Conclusion We found that the diagnostic performance of the ACR 1997, SLICC 2012, and EULAR/ACR 2019 criteria differed between adult-onset and childhood-onset SLE. EULAR/ACR 2019 performed best for adult-onset SLE and SLICC 2012 was best for childhood-onset SLE in classifying patients with SLE. Systematic review registration [www.ClinicalTrials.gov], identifier [CRD420 21281586].
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Affiliation(s)
- Butsabong Lerkvaleekul
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pantira Chobchai
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Soamarat Vilaiyuk
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,*Correspondence: Soamarat Vilaiyuk,
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11
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Torun ES, Bektaş E, Kemik F, Bektaş M, Çetin Ç, Yalçinkaya Y, Artim Esen B, Gül A, Inanç M. Performances of different classification criteria for systemic lupus erythematosus in a single-center cohort from Turkey. Lupus 2022; 31:1536-1543. [DOI: 10.1177/09612033221126866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Sensitivity and specificity of SLE classification criteria may vary in different populations and clinical settings. In this study, we aimed to compare the performances of three criteria sets/rules (1997, 2012, and 2019) in a large cohort of patients and relevant diseased controls. Methods The medical records of consecutive SLE patients and diseased controls were reviewed for clinical and laboratory features relevant to all sets of criteria. Criteria sets/rules were analyzed based on sensitivity, positive predictive value, specificity, and negative predictive value, using clinical diagnosis with at least 6 months of follow-up as the gold standard. A subgroup analysis was performed in ANA positive patients. Results A total of 393 SLE patients and 308 non-SLE diseased controls were included. Sensitivity was 78.4% for 1997 criteria and was more than 90% for both 2012 (91.9%) and 2019 (94.4%) criteria. Specificity was the highest (95.1%) for 1997 ACR criteria, 91.5% for 2012 SLICC criteria and 91.2% for 2019 EULAR/ACR criteria. When only ANA positive patients were analyzed, sensitivity of each criteria increased by 1%, 0.8%, and 2.2%, respectively. Specificity of 1997 criteria decreased by 2% and specificity of 2012 and 2019 criteria both decreased to less than 90%. Conclusion EULAR/ACR criteria were more sensitive than 1997 criteria and had a comparable performance with SLICC criteria. When only ANA positive patients were analyzed, the presence of false positive results (originated from patients with Sjögren’s disease and antiphospholipid syndrome mainly) decreased the specificity of both SLICC and EULAR/ACR criteria.
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Affiliation(s)
- Ege Sinan Torun
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erdem Bektaş
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatih Kemik
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Bektaş
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Çiğdem Çetin
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Yalçinkaya
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahar Artim Esen
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Gül
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Inanç
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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12
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Cheng S, Ding H, Xue H, Cao L. Evaluation of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in children and adults. Clin Rheumatol 2022; 41:2995-3003. [DOI: 10.1007/s10067-022-06293-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/24/2022] [Accepted: 07/08/2022] [Indexed: 12/13/2022]
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13
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Diagnostic accuracy of the American College of Rheumatology-1997, the Systemic Lupus International Collaborating Clinics-2012, and the European League Against Rheumatism-2019 criteria for juvenile systemic lupus erythematosus: A systematic review and network meta-analysis. Clin Exp Rheumatol 2022; 21:103144. [PMID: 35842200 DOI: 10.1016/j.autrev.2022.103144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022]
Abstract
IMPORTANCE/BACKGROUND Several diagnostic criteria have been developed to effectively diagnose systemic lupus erythematosus (SLE). Three criteria are most common, namely the American College of Rheumatology (ACR)-1997, the Systemic Lupus International Collaborating Clinics (SLICC)-2012, and the European League Against Rheumatism (EULAR/ACR)-2019. Whether they also apply to juvenile SLE is unclear. OBJECTIVE To examine the diagnostic accuracy of ACR-1997, SLICC-2012, and EULAR/ACR-2019 for juvenile SLE. DATA SOURCES A comprehensive search of PubMed, Cochrane, and Embase was conducted up to 26 March 2022. STUDY SELECTION We included all study designs in which patients had any index tests for ACR-1997, SLICC-2012, or EULAR/ACR-2019; both full-text papers and conference abstracts published in English were used. Exclusion criteria were as follows: (1) case reports; (2) adult subjects; or (3) did not report sufficient information to acquire true positive, false positive, true negative, and false negative values of diagnostic criteria. DATA EXTRACTION AND SYNTHESIS Two authors independently screened studies, extracted relevant data, and assessed the risk of bias. MAIN OUTCOMES AND MEASURES First, a meta-analysis of the diagnostic accuracy of EULAR/ACR-2019 and a hierarchical summary receiver operating characteristic (HSROC) model was performed to estimate sensitivity and specificity with 95% confidence intervals (CIs). We then carried out a network meta-analysis to compare the performances of these three diagnostic criteria. RESULTS In total, 17 relevant studies that included 2339 juvenile SLE patients were eligible to analyze pooled accuracy. In the meta-analysis, 10 studies (1613 cases) reported the diagnostic performance of EULAR/ACR-2019, showing a pooled sensitivity of 0.92 (95% CI, 0.89-0.95), pooled specificity of 0.89 (0.77-0.95), and area under HSROC of 0.96 (0.94-0.97). In the network meta-analysis, the SLICC-2012 (0.94, 0.92-0.96) had the highest sensitivity, followed by EULAR/ACR-2019 (0.93, 0.90-0.95), and ACR-1997 (0.78, 0.72-0.82); the ACR-1997 (0.96, 0.92-0.98) demonstrated the highest specificity. EULAR/ACR-2019 (0.92, 0.87-0.96) and SLICC-2012 (0.92, 0.86-0.96) had the similar specificity. CONCLUSIONS AND RELEVANCE We found that the applicability of the new EULAR/ACR-2019 criteria in juvenile SLE is not yet the best diagnostic tool. TRIAL REGISTRATION PROSPERO CRD42022321514.
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14
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Aringer M, Costenbader K, Dörner T, Johnson SR. Advances in SLE classification criteria. J Autoimmun 2022; 132:102845. [PMID: 35725680 DOI: 10.1016/j.jaut.2022.102845] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 01/07/2023]
Abstract
This year, the American College of Rheumatology (ACR) 1982 classification criteria for systemic lupus erythematosus (SLE) celebrate their 40th anniversary. From this start, the quest for optimal SLE criteria has led to the 1997 ACR update, the 2012 publication of the Systemic Lupus International Collaborating Clinics (SLICC) criteria, and, in 2019, the European League Against Rheumatism (EULAR)/ACR classification criteria. The latter have since been externally validated in more than two dozen studies and have become the gold standard inclusion criterion of SLE clinical trials. This comprehensive review attempts to follow the evolving success story of SLE classification, highlighting relevant decisions and their rationale, and discussing consequences for the way SLE is defined and managed.
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Affiliation(s)
- Martin Aringer
- Division of Rheumatology, Department of Medicine III, and University Center for Autoimmune and Rheumatic Entities (UCARE). University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany.
| | - Karen Costenbader
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Dörner
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany
| | - Sindhu R Johnson
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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15
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Performance of the EULAR/ACR 2019 classification criteria for systemic lupus erythematous in monogenic lupus. Clin Rheumatol 2022; 41:2721-2727. [PMID: 35590114 DOI: 10.1007/s10067-022-06209-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/10/2022] [Accepted: 04/30/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the application of the EULAR/ACR-2019 criteria to monogenic lupus patients and compare its performance against the SLICC-2012 criteria. METHODS In a multicenter retrospective cohort study, consecutive patients with monogenic lupus from three tertiary lupus clinics were enrolled. The diagnosis of monogenic lupus was based on the expert physician's opinion or fulfilling the SLICC-2012 criteria. All enrolled patients had genetic variants. A control group of sporadic childhood SLE (cSLE) and non-SLE patients, were included. A descriptive data analysis was conducted, and the EULAR/ACR-2019 and SLICC-2012 criteria were applied to both groups. RESULTS Forty-nine patients with monogenic lupus with a median age at diagnosis of 6.0 (IQR 3.0-10.8) years and 104 controls (55 patients with cSLE and 49 non-lupus patients with a median age at diagnosis of 10.0 and 5.0 respectively) were included. Forty-four (89.8%) patients with monogenic lupus fulfilled the EULAR/ACR-2019 with a mean score of 22.3±8.9. The most frequent domains were immunologic (93.9%), musculoskeletal and renal (each 57.1%), and mucocutaneous (55.1%). Fifty-four (98.2%) cSLE patients and six (12.2%) non-lupus patients met the EULAR/ACR-2019 criteria with a mean score of 22.5±9.2 and 8.5±5.2, respectively. The sensitivity of the EULAR/ACR-2019 criteria in monogenic lupus was 89.9% (95% CI: 78.3-90.2), while the specificity was 87.6% (95% CI: 75.2-88.7). CONCLUSION This is the first and largest cohort of monogenic lupus patients testing the performance of the 2019-EULAR/ACR criteria. It efficiently classifies monogenic lupus patients, irrespective of the underlying genetic variants. Further studies are needed before these criteria are adopted worldwide. Key Points • Typically, patients with monogenic lupus have early onset severe disease, especially with mucocutaneous manifestations and a strong family history of SLE. • Monogenic lupus is a distinctive entity and might differ from the sporadic childhood SLE. • Our study includes a large multinational cohort of monogenic lupus with heterogeneous phenotypic features and underlying genetic variants. • Our study demonstrates that the EULAR/ACR-2019 criteria efficiently classified monogenic lupus patients, irrespective of the diversity of the underlying genetic variants.
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16
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Aringer M, Costenbader K, Johnson SR. Assessing the EULAR/ACR classification criteria for patients with systemic lupus erythematosus. Expert Rev Clin Immunol 2022; 18:135-144. [DOI: 10.1080/1744666x.2022.2033617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Martin Aringer
- Division of Rheumatology, Department of Medicine III, and University Center for Autoimmune and Rheumatic Entities (UCARE), University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden
| | - Karen Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, MA
| | - Sindhu R. Johnson
- Mount Sinai Hospital, Toronto Western Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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17
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Lythgoe H, Lj M, Hedrich CM, Aringer M. Classification of systemic lupus erythematosus in children and adults. Clin Immunol 2021; 234:108898. [PMID: 34856381 DOI: 10.1016/j.clim.2021.108898] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/24/2022]
Abstract
Systemic Lupus Erythematosus (SLE) is an autoimmune multisystem disease with a variable clinical phenotype and no single clinical, laboratory or pathological feature that can be used as a gold standard for disease classification or diagnosis. Classification criteria have been developed in an attempt to define homogenous groups of SLE patients for clinical research. They have been mainly validated in adult cohorts, given the much lower prevalence of SLE before puberty. The three commonly used sets of current classification criteria and their validation studies to date are described in this review. Challenges relating to classification of SLE patients, including important differences across age-groups and ethnicities, are explored along with future directions in the classification of SLE.
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Affiliation(s)
- H Lythgoe
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - McCann Lj
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - C M Hedrich
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK; Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - M Aringer
- Department of Rheumatology, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Germany.
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18
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Guavita-Navarro D, Gallego-Cardona L, Arredondo AM, Cubides H, Cajamarca-Barón J, Ibáñez C, Escobar A, Rojas-Villarraga A. Comparison of the sensitivity of the EULAR / ACR 2019 and SLICC 2012 classification criteria in a Colombian population with systemic lupus erythematosus. J Transl Autoimmun 2021; 4:100133. [PMID: 34825157 PMCID: PMC8603195 DOI: 10.1016/j.jtauto.2021.100133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND /Objective: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a wide range of clinical manifestations. The latest classification criteria, EULAR/ACR 2019, have not been validated in a Latin American population of Amerindian ancestry. The objective of this study is to compare the sensitivity of the EULAR/ACR 2019 and SLICC 2012 classification criteria in a group of SLE patients with the above ancestry. METHODS A cross-sectional study was done. Data were obtained from the review of medical records of patients who met the inclusion criteria. The overall sensitivity of the criteria was calculated and compared to each other using the McNemar test. RESULTS 146 medical records of patients from two referral centers were included. There were no differences in the sensitivity of the EULAR/ACR and SLICC 2012 criteria (84.9% versus 85.6% p = 0.79) nor were differences found when the groups based on disease duration were compared: less than 5 years (91.0% versus 92.5% p = 0.70), between 5 and 10 years (82.8% versus 82.8% p = 1), and 10 years or more (76.7% versus 76.7% p = 1). However, SLICC 2012 criteria was found to better classify patients with a less than 5-year disease duration compared to those with 10-year duration or more (92.5% versus 76.4% p = 0.024). CONCLUSIONS There are no statistically significant differences between the EULAR/ACR and SLICC 2012 criteria in the population studied. Nor were differences found when evaluating them by age at diagnosis and duration of the disease except when the group with less than 5 years of duration was compared to those with 10 years or more using the SLICC 2012 criteria.
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Affiliation(s)
- Diana Guavita-Navarro
- Department of Rheumatology, Hospital de San José, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, 111221, Colombia
| | - Laura Gallego-Cardona
- Department of Rheumatology, Hospital de San José, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, 111221, Colombia
| | - Ana María Arredondo
- Department of Rheumatology, Hospital de San José, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, 111221, Colombia
| | - Hector Cubides
- Department of Rheumatology, Hospital de San José, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, 111221, Colombia
| | - Jairo Cajamarca-Barón
- Department of Rheumatology, Hospital de San José, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, 111221, Colombia
| | - Claudia Ibáñez
- Research Division, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, 111221, Colombia
| | - Alejandro Escobar
- Department of Rheumatology, Hospital de San José, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, 111221, Colombia
| | - Adriana Rojas-Villarraga
- Research Division, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, 111221, Colombia
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Smith EMD, Rasul S, Ciurtin C, Al-Abadi E, Armon K, Bailey K, Brennan M, Gardner-Medwin J, Haslam K, Hawley D, Lane S, Leahy A, Leone V, Malik G, Mewar D, Moots R, Pilkington C, Ramanan AV, Rangaraj S, Ratcliffe A, Riley P, Sen E, Sridhar A, Wilkinson N, Beresford MW, McCann LJ, Hedrich CM. Limited sensitivity and specificity of the ACR/EULAR-2019 classification criteria for SLE in JSLE?-observations from the UK JSLE Cohort Study. Rheumatology (Oxford) 2021; 60:5271-5281. [PMID: 33690793 PMCID: PMC8566265 DOI: 10.1093/rheumatology/keab210] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This study aimed to test the performance of the new ACR and EULAR criteria, that include ANA positivity as entry criterion, in JSLE. METHODS Performance of the ACR/EULAR-2019 criteria were compared with Systemic Lupus International Collaborating Clinics (SLICC-2012), using data from children and young people (CYP) in the UK JSLE Cohort Study (n = 482), with the ACR-1997 criteria used as reference standard. An unselected cohort of CYP positive for ANA (n = 129) was used to calculate positive/negative predictive values of the criteria. RESULTS At both first and last visits, the number of patients fulfilling the different classification criteria varied significantly (P < 0.001). The sensitivity of the SLICC-2012 criteria was higher when compared with that of the ACR/EULAR-2019 criteria at first and last visits (98% vs 94% for first visit, and 98% vs 96% for last visit; P < 0.001), when all available CYP were considered. The ACR/EULAR-2019 criteria were more specific when compared with the SLICC-2012 criteria (77% vs 67% for first visit, and 81% vs 71% for last visit; P < 0.001). Significant differences between the classification criteria were mainly caused by the variation in ANA positivity across ages. In the unselected cohort of ANA-positive CYP, the ACR/EULAR-2019 criteria produced the highest false-positive classification (6/129, 5%). CONCLUSION In CYP, the ACR/EULAR-2019 criteria are not superior to those of the SLICC-2012 or ACR-1997 criteria. If classification criteria are designed to include CYP and adult populations, paediatric rheumatologists should be included in the consensus and evaluation process, as seemingly minor changes can significantly affect outcomes.
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Affiliation(s)
- Eve M D Smith
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Sajida Rasul
- Department of Paediatric Rheumatology, Royal Manchester Children’s Hospital, Manchester
| | - Coziana Ciurtin
- Department of Rheumatology, Centre for Adolescent Rheumatology, University College London, London
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children’s Hospital, Birmingham
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Mary Brennan
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield
| | - Steven Lane
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds
| | - Gulshan Malik
- Paediatric Rheumatology, Royal Aberdeen Children’s Hospital, Aberdeen
| | - Devesh Mewar
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool
| | - Robert Moots
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk
| | | | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham
| | | | - Phil Riley
- Department of Paediatric Rheumatology, Royal Manchester Children’s Hospital, Manchester
| | - Ethan Sen
- Paediatric Rheumatology, Great North Children’s Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne
| | - Arani Sridhar
- Leicester Children’s Hospital, University Hospitals of Leicester NHS trust, Leicester
| | - Nick Wilkinson
- Department of Paediatric Rheumatology, Guy’s & St Thomas’s NHS Foundation Trust, Evelina Children’s Hospital, London, UK
| | - Michael W Beresford
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Liza J McCann
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Christian M Hedrich
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
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20
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Pitta AC, Silva CA, Insfrán CE, Pasoto SG, Trindade VC, Novak GV, Sakamoto AP, Terreri MT, Pereira RM, Magalhães CS, Fonseca AR, Islabão AG, Assad AP, Buscatti IM, Elias AM, Piotto DP, Ferriani VP, Carvalho LM, Rabelo Junior CN, Marini R, Sztajnbok FR, Sacchetti SB, Bica BE, Moraes AJ, Robazzi TC, Lotufo S, Cavalcanti AS, Naka EN, Carneiro-Sampaio M, Bonfá E, Aikawa NE. The new 2019-EULAR/ACR classification criteria specific domains at diagnosis can predict damage accrual in 670 childhood-onset systemic lupus erythematosus patients. Lupus 2021; 30:2286-2291. [PMID: 34689652 DOI: 10.1177/09612033211054397] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate if the 2019-European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) criteria at diagnosis of childhood-onset systemic lupus erythematosus (cSLE) are associated with higher rates of early damage scored by Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI). METHODS This retrospective multicenter study included 670 cSLE patients with ≤5 years of disease duration. All patients fulfilled both 2019-EULAR/ACR and 1997-ACR classification criteria. Total score of 2019-EULAR/ACR criteria and each of its specific domains were assessed at diagnosis as predictors of damage accrual at the last visit, according to the presence of any organ damage (defined by SDI ≥ 1). RESULTS Median disease duration was 2.8 (IQR 1.8-3.8) years and 200 (29.9%) patients had at least one organ damage (SDI ≥ 1). The most frequent domains were neuropsychiatric (12%), renal (7%), and musculoskeletal (6%). There was a higher frequency of renal (58% vs 43%, p = 0.0004) and neuropsychiatric domain (21% vs 7%, p < 0.0001) of 2019-EULAR/ACR criteria in patients with damage (SDI ≥ 1) compared to those without damage (SDI = 0). Patients scoring renal or neuropsychiatric domains of the 2019-EULAR/ACR criteria at diagnosis were associated with renal damage (odds ratio 9.701, 95% confidence interval 3.773-24.941, p < 0.001) or neuropsychiatric damage (OR 9.480, 95% CI 5.481-16.399, p<0.0001) at latest visit, respectively. cSLE patients with positive anti-dsDNA at diagnosis were also associated with renal damage by the latest visit (OR 2.438, 95% CI 1.114-5.3381, p = 0.021). Constitutional, hematologic, mucocutaneous, serosal, and musculoskeletal domains and specific criteria as well as other immunologic criteria were not associated with damage accrual. Median of SLEDAI-2K was significantly higher in patients with global damage (19.5 (2-51) vs 14 (0-51), p<0.001). 2019-EULAR/ACR score >25 was associated with more overall (SDI ≥ 1) (38% vs 25%, p = 0.0002) and renal damage (11% vs 5%, p = 0.023). CONCLUSIONS The 2019-EULAR/ACR criteria at diagnosis were associated with a higher rate of early damage in cSLE patients, especially for renal and neuropsychiatric damage. Of note, damage was particularly associated with high disease activity at diagnosis and 2019-EULAR/ACR score >25.
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Affiliation(s)
- Ana C Pitta
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Division of Rheumatology, 117265Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Division of Rheumatology, 117265Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos E Insfrán
- Division of Rheumatology, 117265Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra G Pasoto
- Division of Rheumatology, 117265Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vitor C Trindade
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Glaucia V Novak
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana P Sakamoto
- Pediatric Rheumatology Unit, 28105Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Maria T Terreri
- Pediatric Rheumatology Unit, 28105Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Rosa Mr Pereira
- Division of Rheumatology, 117265Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Claudia S Magalhães
- Pediatric Rheumatology Division, 28108Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Adriana R Fonseca
- Pediatric Rheumatology Unit, 28125Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, Brazil
| | - Aline G Islabão
- Pediatric Rheumatology Unit, Hospital da Criança de Brasília Jose Alencar, Brasília, Brazil.,Post-graduation Program in Medical Science and Rheumatology Unit, University of Brasilia, Brasília, Brazil
| | - Ana Pl Assad
- Division of Rheumatology, 117265Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Izabel M Buscatti
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Adriana M Elias
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniela P Piotto
- Pediatric Rheumatology Unit, 28105Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Virginia P Ferriani
- Pediatric Rheumatology Unit, Ribeirao Preto Medical School - University of Sao Paulo, Ribeirão Preto, Brazil
| | - Luciana M Carvalho
- Pediatric Rheumatology Unit, Ribeirao Preto Medical School - University of Sao Paulo, Ribeirão Preto, Brazil
| | | | - Roberto Marini
- Pediatric Rheumatology Unit, University of Campinas (UNICAMP), Campinas, Brazil
| | - Flavio R Sztajnbok
- Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Silvana B Sacchetti
- Pediatric Rheumatology Unit,Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - Blanca E Bica
- Rheumatology Division - Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Ana J Moraes
- Pediatric Rheumatology Unit, Federal University of Pará, Belém, Brazil
| | - Teresa C Robazzi
- Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, Brazil
| | - Simone Lotufo
- Pediatric Rheumatology Unit, Hospital Menino Jesus, São Paulo, Brazil
| | - Andre S Cavalcanti
- Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, Brazil
| | - Erica N Naka
- Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Magda Carneiro-Sampaio
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfá
- Division of Rheumatology, 117265Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadia E Aikawa
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Division of Rheumatology, 117265Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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21
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Trindade VC, Carneiro-Sampaio M, Bonfa E, Silva CA. An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus. Paediatr Drugs 2021; 23:331-347. [PMID: 34244988 PMCID: PMC8270778 DOI: 10.1007/s40272-021-00457-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 02/06/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is a prototype of a multisystemic, inflammatory, heterogeneous autoimmune condition. This disease is characterized by simultaneous or sequential organ and system involvement, with unpredictable flare and high levels of morbidity and mortality. Racial/ethnic background, socioeconomic status, cost of medications, difficulty accessing health care, and poor adherence seem to impact lupus outcomes and treatment response. In this article, the management of cSLE patients is updated. Regarding pathogenesis, a number of potential targets for drugs have been studied. However, most treatments in pediatric patients are off-label drugs with recommendations based on inadequately powered studies, therapeutic consensus guidelines, or case series. Management practices for cSLE patients include evaluations of disease activity and cumulative damage scores, routine non-live vaccinations, physical activity, and addressing mental health issues. Antimalarials and glucocorticoids are still the most common drugs used to treat cSLE, and hydroxychloroquine is recommended for nearly all cSLE patients. Disease-modifying antirheumatic drugs (DMARDs) should be standardized for each patient, based on disease flare and cSLE severity. Mycophenolate mofetil or intravenous cyclophosphamide is suggested as induction therapy for lupus nephritis classes III and IV. Calcineurin inhibitors (cyclosporine, tacrolimus, voclosporin) appear to be another good option for cSLE patients with lupus nephritis. Regarding B-cell-targeting biologic agents, rituximab may be used for refractory lupus nephritis patients in combination with another DMARD, and belimumab was recently approved by the US Food and Drug Administration for cSLE treatment in children aged > 5 years. New therapies targeting CD20, such as atacicept and telitacicept, seem to be promising drugs for SLE patients. Anti-interferon therapies (sifalimumab and anifrolumab) have shown beneficial results in phase II randomized control trials in adult SLE patients, as have some Janus kinase inhibitors, and these could be alternative treatments for pediatric patients with severe interferon-mediated inflammatory disease in the future. In addition, strict control of proteinuria and blood pressure is required in cSLE, especially with angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use.
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Affiliation(s)
- Vitor Cavalcanti Trindade
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Clovis Artur Silva
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
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22
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Abstract
Since the European League Against Rheumatism/American College of Rheumatology 2019 classification criteria for systemic lupus erythematosus (SLE) were published, they were externally validated by groups worldwide. In particular, the new criteria worked well also in East Asian and pediatric cohorts. Antinuclear antibodies (ANA) as an entry criterion were critically discussed, but the group of ANA-negative patients is small (<5%) worldwide. Specificity of the criteria is dependent on correct attribution only of those criteria that are not better explained by other causes. Although the classification criteria should not be used for diagnosis, many novel aspects inform diagnostic considerations.
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23
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Magallares B, Lobo-Prat D, Castellví I, Moya P, Gich I, Martinez-Martinez L, Park H, Millán AM, Laiz A, Díaz-Torné C, Fernandez S, Corominas H. Assessment of EULAR/ACR-2019, SLICC-2012 and ACR-1997 Classification Criteria in SLE with Longstanding Disease. J Clin Med 2021; 10:jcm10112377. [PMID: 34071275 PMCID: PMC8198204 DOI: 10.3390/jcm10112377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Different classification criteria for systemic lupus erythematosus (SLE) have been launched over the years. Our aim was to evaluate the performance of the EULAR/ACR-2019, SLICC-2012 and ACR-1997 classification criteria in a cohort of SLE patients with longstanding disease. METHODS Descriptive observational study in 79 patients with established and longstanding SLE. The three classification criteria sets were applied to those patients. RESULTS Of the 79 patients, 70 were women (88.6%), with a mean age of 51.8 ± 14 years and a mean disease duration of 15.2 ± 11.5 years. The sensitivity of the different criteria were: 51.9%, 87.3% and 86.1% for ACR-1997, SLICC-2012 and EULAR/ACR-2019, respectively. In total, 68 out of 79 patients (53.7%) met all three classification criteria; 11.4% did not meet any classification criteria and were characterized by low SLEDAI (0.6 ± 0.9), low SLICC/ACR Damage Index (0.88 ± 0.56) and fulfilling only skin domains, antiphospholipid antibodies or hypocomplementemia. To fulfill EULAR/ACR-2019 criteria was associated with low complement levels (p < 0.04), high anti-dsDNA levels (p < 0.001), presence of lupus nephritis III-IV (p < 0.05) and arthritis (p < 0.001). CONCLUSION The EULAR/ACR-2019 classification criteria showed high sensitivity, similar to SLICC-2012, in SLE patients with longstanding disease. Patients with serological, articular or renal involvement are more likely to fulfill SLICC-2012 or EULAR/ACR-2019 criteria.
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Affiliation(s)
- Berta Magallares
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (B.M.); (D.L.-P.); (I.C.); (P.M.); (H.P.); (A.M.M.); (A.L.); (C.D.-T.); (S.F.)
- Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain;
- Department of Immunology, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - David Lobo-Prat
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (B.M.); (D.L.-P.); (I.C.); (P.M.); (H.P.); (A.M.M.); (A.L.); (C.D.-T.); (S.F.)
| | - Ivan Castellví
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (B.M.); (D.L.-P.); (I.C.); (P.M.); (H.P.); (A.M.M.); (A.L.); (C.D.-T.); (S.F.)
- Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain;
- Department of Immunology, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Patricia Moya
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (B.M.); (D.L.-P.); (I.C.); (P.M.); (H.P.); (A.M.M.); (A.L.); (C.D.-T.); (S.F.)
- Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain;
- Department of Immunology, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Ignasi Gich
- Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | | | - Hye Park
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (B.M.); (D.L.-P.); (I.C.); (P.M.); (H.P.); (A.M.M.); (A.L.); (C.D.-T.); (S.F.)
| | - Ana Milena Millán
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (B.M.); (D.L.-P.); (I.C.); (P.M.); (H.P.); (A.M.M.); (A.L.); (C.D.-T.); (S.F.)
| | - Ana Laiz
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (B.M.); (D.L.-P.); (I.C.); (P.M.); (H.P.); (A.M.M.); (A.L.); (C.D.-T.); (S.F.)
- Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain;
- Department of Immunology, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - César Díaz-Torné
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (B.M.); (D.L.-P.); (I.C.); (P.M.); (H.P.); (A.M.M.); (A.L.); (C.D.-T.); (S.F.)
- Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain;
- Department of Immunology, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Susana Fernandez
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (B.M.); (D.L.-P.); (I.C.); (P.M.); (H.P.); (A.M.M.); (A.L.); (C.D.-T.); (S.F.)
| | - Hèctor Corominas
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (B.M.); (D.L.-P.); (I.C.); (P.M.); (H.P.); (A.M.M.); (A.L.); (C.D.-T.); (S.F.)
- Sant Pau Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain;
- Department of Immunology, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
- Correspondence: ; Tel.: +34-932919000
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24
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Abstract
PURPOSE OF REVIEW Juvenile-onset systemic lupus erythematosus ((j)SLE) is an autoimmune/inflammatory disease that results in significant damage and disability. When compared to patients with disease onset in adulthood, jSLE patients exhibit increased disease activity, damage and require more aggressive treatments. This manuscript summarises age-specific pathogenic mechanisms and underscores the need for age group-specific research, classification and treatment. RECENT FINDINGS Genetic factors play a significant role in the pathophysiology of jSLE, as > 7% of patients develop disease as a result of single gene mutations. Remaining patients carry genetic variants that are necessary for disease development, but require additional factors. Increased 'genetic impact' likely contributes to earlier disease onset and more severe phenotypes. Epigenetic events have only recently started to be addressed in jSLE, and add to the list of pathogenic mechanisms that may serve as biomarkers and/or treatment targets. To allow meaningful and patient-oriented paediatric research, age-specific classification criteria and treatment targets require to be defined as currently available tools established for adult-onset SLE have limitations in the paediatric cohort. Significant progress has been made in understanding the pathophysiology of jSLE. Meaningful laboratory and clinical research can only be performed using age group-specific tools, classification criteria and treatment targets.
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Affiliation(s)
- A Charras
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
- Institute in the Park, Alder Hey Children's NHS Foundation Trust Hospital, East Prescot Road, Liverpool, L14 5AB, UK.
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25
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Levinsky Y, Broide M, Kagan S, Goldberg O, Scheuerman O, Tal R, Tirosh I, Butbul Y, Furst DE, Harel L, Amarilyo G. Performance of 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in a paediatric population—a multicentre study. Rheumatology (Oxford) 2021; 60:5142-5148. [DOI: 10.1093/rheumatology/keab140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/18/2021] [Indexed: 02/03/2023] Open
Abstract
AbstractObjectivesThe European League Against Rheumatism and American College of Rheumatology 2019 (EULAR/ACR-19) criteria for the diagnosis of 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. The aim of this study is to examine their application to juvenile SLE (jSLE) patients.MethodsIn this multicentre study the charts of jSLE patients from three tertiary medical centres were reviewed and compared with patients with non-jSLE diagnosis. Paediatric rheumatologists, blinded to the original diagnosis, reviewed and diagnosed all cases. Paediatric patients' clinical and laboratory data were retrospectively extracted and then examined with regard to how they met the new and old criteria.ResultsIncluded 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 (95% CI: 0.9, 0.99) and the specificity was 0.89 (95% CI: 0.82, 0.94). These were comparable to the SLICC criteria. The sensitivity of the EULAR/ACR-19 criteria improves over time and was 0.83 12 months following disease onset, reaching 0.96 after longer than 24 months.ConclusionAmong 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 with the SLICC-12 criteria. We support the use of the new classification criteria for paediatric patients in future jSLE studies, but it should be noted that its specificity is lower than for adults.
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Affiliation(s)
- Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Mor Broide
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Pediatrics A, Schneider Children's Medical Center
| | - Shelly Kagan
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ori Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Pulmonary Unit
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Rotem Tal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva
| | - Irit Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Service, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer
| | - Yoni Butbul
- Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Daniel E Furst
- Department of Medicine, Rheumatology Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy and
- Department of Rheumatology, University of Washington, Seattle, WA, United States
| | - Liora Harel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva
| | - Gil Amarilyo
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva
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