The use of SLICC and ACR criteria to correctly label patients with cutaneous lupus and systemic lupus erythematosus

Comparison of patients with isolated cutaneous lupus erythematosus versus systemic lupus erythematosus with cutaneous lupus erythematosus as the sole clinical feature: A monocentric study of 149 patients

BACKGROUND

Cutaneous lupus erythematosus (CLE) may present as an isolated entity or be classified as Systemic lupus erythematosus (SLE) by the presence of laboratory abnormalities, including cytopenia, low complement levels, and/or autoantibodies (CLE with laboratory SLE).

OBJECTIVE

To compare isolated CLE and CLE with laboratory SLE and to validate an existing 3-item score with age < 25 years (1 point), phototypes V to VI (1 point), antinuclear antibodies ≥ 1:320 (5 points) to predict the risk of progression from CLE to severe SLE (sSLE).

METHODS

Monocentric cohort study including consecutive patients with CLE. CLE with laboratory SLE was defined by 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for SLE score of ≥10 points at baseline with CLE as the sole clinical feature.

RESULTS

Of the 149 patients with CLE, 20 had CLE with laboratory SLE. The median follow-up duration was 11.3 years (IQR: 5.1-20.5). Ten patients (7%) had sSLE developed. In survival analysis, the risk of progression to sSLE was higher among CLE with laboratory SLE (hazard ratio = 6.69; 95% CI: 1.93-23.14, P < .001) compared to isolated CLE. In both groups, none of the patients with a risk score ≤ 2 had sSLE developed.

LIMITATIONS

Monocentric study with a limited number of patients.

CONCLUSIONS

CLE with laboratory patients with SLE have a higher risk of progression to sSLE than isolated CLE.

Serum miR-342-3p Acts as a Biomarker for Systemic Lupus Erythematosus and Participates in the Disease Progression

Purpose

The aim of this study was to investigate the diagnostic ability and prognostic value of miR-342-3p in SLE patients by detecting the expression level of serum miR-342-3p in SLE patients.

Patients and Methods

The expression level of serum miR-342-3p in all subjects was determined by qRT-PCR technology, and the correlation of miR-342-3p with SLEDAI scores was evaluated using Spearman correlation coefficient. The diagnostic value of miR-342-3p in SLE was assessed using ROC curve. The prognostic value of miR-342-3p in SLE patients was analyzed by Kaplan-Meier survival curve and multivariate COX regression.

Results

The qRT-PCR results showed that the expression level of serum miR-342-3p in SLE patients was significantly lower than that in healthy controls (P < 0.001). Serum miR-342-3p expression level was negatively correlated with SLEDAI scores (r = - 0.810, P < 0.001). The ROC curve suggested that serum miR-342-3p expression level was discriminative between SLE patients and healthy controls. Survival analysis results indicated that SLE patients with low serum miR-342-3p expression had a higher probability of poor prognosis of SLE (Log rank P = 0.003).

Conclusion

The expression level of serum miR-342-3p was valuable in the diagnosis of SLE. Meanwhile, the low expression level of serum miR-342-3p was associated with the poor prognosis of SLE.

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

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].

A comparison and review of three sets of classification criteria for systemic lupus erythematosus for distinguishing systemic lupus erythematosus from pure mucocutaneous manifestations in the lupus disease spectrum

Although the original purpose of the systemic lupus erythematosus (SLE) classification criteria was to distinguish SLE from other mimic diseases, and to facilitate sample selection in scientific research, they have become widely used as diagnostic criteria in clinical situations. It is not known yet if regarding classification criteria as diagnostic criteria, what problems might be encountered? This is the first study comparing the three sets of classification criteria for SLE, the 1997 American College of Rheumatology (ACR’97), 2012 Systemic Lupus International Collaborating Clinics (SLICC’12) and 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR’19), for their ability to distinguish patients with SLE from patients with pure mucocutaneous manifestations (isolated cutaneous lupus erythematosus without internal disease, i-CLE) in the lupus disease spectrum. 1,865 patients with SLE and 232 patients with i-CLE were recruited from a multicenter study. We found that, due to low specificity, none of the three criteria are adept at distinguishing patients with SLE from patients with i-CLE. SLICC’12 performed best among the original three criteria, but if a positive ANA was removed as an entry criterion, EULAR/ACR’19 would performed better. A review of previous studies that compared the three sets of criteria was presented in this work.

Multidisciplinary care in patients with systemic lupus erythematosus: a randomized controlled trial in China

Background For the large number of systemic lupus erythematosus (SLE) patients in China, it is critical to carry out effective disease management to improve the treatment effect and reduce disease burden. A pharmacist-led multidisciplinary care model has not been reported in Chinese SLE patients before. Objective To assess the effect of patient-centered, pharmacist-led, multidisciplinary care on clinical outcomes and satisfaction with health care in Chinese SLE patients. Setting: The South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Method Participants were 143 systemic lupus erythematosus patients randomly assigned to either the intervention group (multidisciplinary care: physician, pharmacist and nurse) or the control group (usual care only). Main outcome measures The primary outcome was scores on the systemic lupus erythematosus disease activity index-2000, the satisfaction with information about medicines scale, and the EuroQol five-dimension questionnaire, assessed at baseline and 12 months. Results Between October 1, 2017 and October 1, 2018, 42 participants were included in the intervention group and 40 in the control group. At 12 months, results for the systemic lupus erythematosus disease activity index-2000 differed significantly between the intervention group and the control group (0 vs. 2, P = 0.027). Patient satisfaction with health care was also significantly greater in the intervention group than in the control group (92.9 vs. 0%, P = 0.000). According to the EuroQol five-dimension questionnaire, health quality was also improved (0.94 vs. 0.85, P = 0.006). Conclusion Our multidisciplinary care team significantly improved clinical outcomes and satisfaction with drug information in Chinese systemic lupus erythematosus patients.

Lack of patient education is risk factor of disease flare in patients with systemic lupus erythematosus in China

BACKGROUND

To explore the inadequacies of health service and its impact on clinical outcomes of patients with systemic lupus erythematosus (SLE) in China.

METHODS

A total of 210 SLE patients were randomly recruited between January 2017 and January 2018. Each patient received self-report questionnaires to assess medication adherence [Compliance Questionnaire for Rheumatology (CQR)], beliefs about medicines [Beliefs about Medicines Questionnaire (BMQ)] and satisfaction about medicine information [the Satisfaction with Information about Medicines Scale (SIMS)]. Associations between SLE disease activity index (SLEDAI-2 K) and observed factors were analyzed by multiple logistic regression.

RESULTS

Based on CQR, only 28.10% patients were adherent. The score of BMQ was 2.85 ± 5.42, and merely 32.38% patients were satisfied with the information about their prescribed medicines. Disease activity was associated with SIMS, EuroQol five-dimensions [EQ5D], Systemic Lupus International Collaborating Clinics (SLICC), depression, use of NSAID (P ≤ 0.05). Remission of disease was positively correlated with SIMS (OR = 0.16, 95% CI: [0.06, 0.40]), and BMQ (OR = 0.64, 95%CI: [0.43, 0.94]).

CONCLUSION

In this study, the scores of BMQ and SIMS were low, implying defects in the patient education of health service system, which led to disease flare in Chinese SLE patients.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03024307 . Registered January 18, 2017.