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Johnson SR, Alahmari H, Bonilla D, Ahmad Z, Bookman A, Hiraki LT, Silverman E, Touma Z, Movahedi M, Wither JE. Evaluation of Progression From Preclinical to Systemic Autoimmune Rheumatic Disease: Novel Use of the European Alliance of Associations for Rheumatology/American College of Rheumatology Systemic Lupus Erythematosus Classification Criteria as an Outcome Measure. ACR Open Rheumatol 2024. [PMID: 39348240 DOI: 10.1002/acr2.11723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 10/02/2024] Open
Abstract
OBJECTIVE Our objective was to evaluate the development of a systemic autoimmune rheumatic disease (SARD) in undifferentiated and asymptomatic individuals with antinuclear antibodies (ANAs). We comparatively evaluated those who did and did not develop a SARD and fulfillment of classification criteria. METHODS We conducted a cohort study of undifferentiated and asymptomatic patients with ANAs who were assessed for the development of a SARD. The primary outcome was a diagnosis of a SARD over a two-year period. We assessed fulfillment of classification criteria. Risk ratios (RRs) were used to evaluate differences among those who did and did not progress to a SARD. RESULTS We evaluated 207 asymptomatic ANA-positive or undifferentiated patients, of whom 23 (11%) progressed to a SARD, whereas 187 (89%) did not progress. Progressors developed systemic lupus erythematosus (SLE) (n = 11 [48%]), Sjögren disease (n = 5 [22%]), systemic sclerosis (n = 3 [13%]), rheumatoid arthritis (n = 1 [4%]), and from ANA-positive to undifferentiated connective tissue disease (n = 3 [13%]). Fever (RR 0.89, 95% confidence interval [CI] 0.8-0.93) and antiphospholipid antibodies (RR 0.89, 95% CI 0.87-0.93) occurred less frequently, whereas arthritis (RR 1.74, 95% CI 1.20-2.55) occurred more frequently in progressors. Progressors to SLE had arthritis (91%), whereas none developed delirium, psychosis, or nephritis. Among patients with SLE, 100% fulfilled the EULAR/American College of Rheumatology (ACR) SLE criteria (sensitivity 91.7%, specificity 100%), whereas 73% fulfilled the 1997 ACR SLE criteria (sensitivity 81.8%, specificity 98.9%). CONCLUSION Most undifferentiated/asymptomatic individuals with ANA do not progress to a SARD over a two-year period. SLE progressors appear to have mild disease in the short term. The EULAR/ACR SLE criteria have improved ability to identify those who develop SLE.
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Affiliation(s)
- Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Hana Alahmari
- Schroeder Arthritis Institute, Toronto Western Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Dennisse Bonilla
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | | | - Arthur Bookman
- University Health Network and University of Toronto, Toronto, Canada
| | - Linda T Hiraki
- Sick Children's Hospital and University of Toronto, Toronto, Canada
| | - Earl Silverman
- Sick Children's Hospital and University of Toronto, Toronto, Canada
| | - Zahi Touma
- Schroeder Arthritis Institute, Toronto Western Hospital and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Movahedi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Joan E Wither
- University of Toronto, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada
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Haukeland H, Moe SR, Brunborg C, Botea A, Damjanic N, Wivestad GÅ, Øvreås HK, Bøe TB, Orre A, Torhild G, Sanner H, Lerang K, Molberg Ø. Sensitivity of classification criteria from time of diagnosis in an incident systemic lupus erythematosus cohort: a population-based study from Norway. RMD Open 2024; 10:e004395. [PMID: 39160088 PMCID: PMC11337708 DOI: 10.1136/rmdopen-2024-004395] [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: 04/05/2024] [Accepted: 07/07/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES To compare the sensitivity of 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) classification criteria against 1997 ACR criteria for systemic lupus erythematosus (SLE), for incident SLE cases in the presumably complete population-based Nor-SLE cohort from Southeast Norway (2.9 million inhabitants). METHODS All cases International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coded as SLE during 2000-2017 were individually reviewed. Those with a confirmed SLE diagnosis by expert clinical assessment were included in the Nor-SLE cohort. Core clinical data were recorded, and the cases were classified according to 2019 EULAR/ACR and 1997 ACR criteria. Juvenile SLE was defined as <16 years at diagnosis and adult SLE was defined as ≥16 years at diagnosis. RESULTS We included 737 incident SLE cases (701 adults, 36 juveniles). At diagnosis, 2019 EULAR/ACR criteria were more sensitive than 1997 ACR criteria for adults (91.6% vs 77.3%; p<0.001), but not for juveniles (97.2% vs 88.9%). The 2019 EULAR/ACR counts at diagnosis differed by age group and ethnicity, being higher in young cases and those originating from Asia. From time of diagnosis to study end the fulfilment rate of 2019 EULAR/ACR criteria for the adult cohort increased from 92.5% and 86.5% to 94.6% and 91.0%, respectively, for females and males (mean disease duration of 7.5 years). CONCLUSION Showing 92% criteria fulfilment already at time of SLE diagnosis by 2019 EULAR/ACR criteria versus 77% by 1997 ACR criteria, the results from this population-based study suggest that the 2019 EULAR/ACR criteria will achieve its goal of capturing more early-SLE cases for clinical trials.
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Affiliation(s)
- Hilde Haukeland
- Department of Rheumatology, Martina Hansens Hospital, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigrid Reppe Moe
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Antonela Botea
- Department of Rheumatology, Betanien Hospital, Skien, Norway
| | - Nenad Damjanic
- Department of Rheumatology, Østfold Hospital Trust, Grålum, Norway
| | - Gro Årthun Wivestad
- Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Heidi Kverneggen Øvreås
- Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | | | - Anniken Orre
- Department of Rheumatology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Garen Torhild
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Helga Sanner
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Department of Health Sciences, Oslo New University College, Oslo, Norway
| | - Karoline Lerang
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Øyvind Molberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
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Zhang S, Li X, Chen H, Gao X, Cai Z, Zeng H. Assay for interferon gamma release as a novel marker in pediatric patients with systemic lupus erythematosus. Pediatr Rheumatol Online J 2024; 22:70. [PMID: 39090639 PMCID: PMC11292859 DOI: 10.1186/s12969-024-01008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The interferon-gamma (IFN-γ) release assay (IGRA) is an important laboratory diagnosis for latent Mycobacterium tuberculosis (TB) infection. The TB-IGRA measures the release of IFN-γ from peripheral blood cells, who are exposed to TB antigen (Ag), mitogen (MT), or negative/nil control (NL) in vitro. While, an exceptional higher TB Ag-NL level will reflect an elevation of peripheral lymphocytes released IFN-γ in a same condition. Therefore, we found that the elevated levels of TB Ag-NL could become a new biomarker for the diagnosis and treatment of pediatric systemic lupus erythematosus (SLE) patients. METHODS We have analyzed the clinical data of 776 children who are underwent TB-IGRA testing in the Department of Allergy and Rheumatology of Guangzhou Women and Children's Medical Center from 2018 to 2020. To investigate the association between TB Ag-NL and SLE, we have analyzed the clinical data of 47 SLE patients and TB Ag-NL testing results, and then evaluated the association between TB Ag-NL and SLE disease activity. RESULTS The TB Ag-NL levels were significantly higher in patients with active SLE than those in inactive SLE (p = 0.0002). The TB Ag-NL levels were positively correlated with the SLE disease activity index (SLEDAI) and laboratory diagnosis parameters. The mean value of TB Ag-NL in SLE patients (0.04191 ± 0.07955, IU/mL) were significantly higher than those in patients with juvenile dermatomyositis (JDM) (0.0158 ± 0.0337, IU/mL, p = 0.036), juvenile idiopathic arthritis (JIA) (0.0162 ± 0.0388, IU/mL, p = 0.001), and healthy controls (HC) (0.0001 ± 0.0027, IU/mL, p = 0.0003). Therefore, the elevated TB Ag-NL levels could serve as a potential diagnostic biomarker of SLE, especially for the active SLE. CONCLUSION The detection of IFN-γ release levels by the TB-IGRA may be useful to assess SLE disease activity in pediatric patients with active SLE.
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Affiliation(s)
- Song Zhang
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University,Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Xue Li
- Department of Rheumatology and Immunology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510623, China
| | - Huishan Chen
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University,Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Xianfei Gao
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University,Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Zhe Cai
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University,Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China.
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China.
| | - Huasong Zeng
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University,Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China.
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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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Moysidou GS, Mastrogiorgakis D, Boumpas D, Bertsias G. Management of systemic lupus erythematosus: A new scenario. Best Pract Res Clin Rheumatol 2023; 37:101895. [PMID: 37978040 DOI: 10.1016/j.berh.2023.101895] [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] [Received: 08/31/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
The introduction of targeted biological agents in systemic lupus erythematosus (SLE) has created a momentum for improving overall disease management and patients' prognosis. To achieve this, a comprehensive strategy is required spanning the entire patient journey from diagnosis to prevention and management of late complications and comorbidities. In this review, we focus on four aspects that are closely linked to SLE prognosis, namely early disease recognition and treatment initiation, reduction of the cumulative glucocorticoid exposure, attainment of well-defined targets of remission and low disease activity, prevention of flares and, kidney-protective strategies with non-immune-directed agents. We review the recent literature related to these topics in conjunction with the existing treatment recommendations, highlighting areas of uncertainty and providing guidance towards facilitating the care of SLE patients.
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Affiliation(s)
- Georgia-Savina Moysidou
- Rheumatology-Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Mastrogiorgakis
- Rheumatology, Clinical Immunology and Allergy, University Hospital of Iraklio and University of Crete Medical School, Iraklio, Greece
| | - Dimitrios Boumpas
- Rheumatology-Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece; Laboratory of Autoimmunity and Inflammation, Centre of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University Hospital of Iraklio and University of Crete Medical School, Iraklio, Greece; Laboratory of Rheumatology, Autoimmunity and Inflammation, Institute of Molecular Biology and Biotechnology, Foundation for Research & Technology - Hellas (FORTH), Iraklio, Greece.
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Dissaux N, Neyme P, Kim-Dufor DH, Lavenne-Collot N, Marsh JJ, Berrouiguet S, Walter M, Lemey C. Psychosis Caused by a Somatic Condition: How to Make the Diagnosis? A Systematic Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1439. [PMID: 37761400 PMCID: PMC10529854 DOI: 10.3390/children10091439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND First episode of psychosis (FEP) is a clinical condition that usually occurs during adolescence or early adulthood and is often a sign of a future psychiatric disease. However, these symptoms are not specific, and psychosis can be caused by a physical disease in at least 5% of cases. Timely detection of these diseases, the first signs of which may appear in childhood, is of particular importance, as a curable treatment exists in most cases. However, there is no consensus in academic societies to offer recommendations for a comprehensive medical assessment to eliminate somatic causes. METHODS We conducted a systematic literature search using a two-fold research strategy to: (1) identify physical diseases that can be differentially diagnosed for psychosis; and (2) determine the paraclinical exams allowing us to exclude these pathologies. RESULTS We identified 85 articles describing the autoimmune, metabolic, neurologic, infectious, and genetic differential diagnoses of psychosis. Clinical presentations are described, and a complete list of laboratory and imaging features required to identify and confirm these diseases is provided. CONCLUSION This systematic review shows that most differential diagnoses of psychosis should be considered in the case of a FEP and could be identified by providing a systematic checkup with a laboratory test that includes ammonemia, antinuclear and anti-NMDA antibodies, and HIV testing; brain magnetic resonance imaging and lumbar puncture should be considered according to the clinical presentation. Genetic research could be of interest to patients presenting with physical or developmental symptoms associated with psychiatric manifestations.
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Affiliation(s)
- Nolwenn Dissaux
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
- Unité de Recherche EA 7479 SPURBO, Université de Bretagne Occidentale, 29200 Brest, France
| | - Pierre Neyme
- Fondation du Bon Sauveur d’Alby, 30 Avenue du Colonel Teyssier, 81000 Albi, France
| | - Deok-Hee Kim-Dufor
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
| | - Nathalie Lavenne-Collot
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
- Laboratoire du Traitement de l’Information Médicale, Inserm U1101, 29200 Brest, France
| | - Jonathan J. Marsh
- Graduate School of Social Service, Fordham University, 113 West 60th Street, New York, NY 10023, USA
| | - Sofian Berrouiguet
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
- Unité de Recherche EA 7479 SPURBO, Université de Bretagne Occidentale, 29200 Brest, France
| | - Michel Walter
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
- Unité de Recherche EA 7479 SPURBO, Université de Bretagne Occidentale, 29200 Brest, France
| | - Christophe Lemey
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
- Unité de Recherche EA 7479 SPURBO, Université de Bretagne Occidentale, 29200 Brest, France
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Hajji M, Gorsane I, Badrouchi S, Litaiem N, Rammeh S, Ben Hamida F, Abderrahim E. Systemic lupus erythematosus presenting as lupus erythematosus tumidus and lupus nephritis: a case report. J Med Case Rep 2023; 17:242. [PMID: 37312164 DOI: 10.1186/s13256-023-03981-3] [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: 03/06/2023] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Lupus nephritis and lupus erythematosus tumidus (LET) are uncommon manifestations of systemic lupus erythematosus (SLE), and their coexistence as the initial presentation of SLE is exceedingly rare. Here, we report such a case, emphasizing the diagnostic challenges and therapeutic implications of this unusual association. CASE REPORT A 38-year-old North African woman presented in Nephrology department with a history of lower extremity edema, fatigue, and weight loss of 3 kg in 4 weeks. Physical examination revealed LET lesions on the chest and the Neck. Laboratory investigations showed lymphopenia, low C3 and C4 complement levels, positive antinuclear antibodies, anti-dsDNA antibodies, and anti-SSA/Ro antibodies. Renal function tests showed normal serum creatinine and nephrotic proteinuria. Renal biopsy revealed Class V lupus nephritis. Skin biopsy confirmed the diagnosis of LET, with the presence of lymphohistiocytic infiltrates and dermal mucin. The patient was diagnosed with SLE based on the 2019 EULAR/ACR criteria and treated with prednisone (1 mg/kg/day) and hydroxychloroquine. She showed significant improvement in her cutaneous and renal symptoms at 6 and 12 months follow-up. CONCLUSION The rarity of the coexistence of LET and lupus nephritis as the initial manifestation of SLE, especially in the North African population, underscores the need for further research to elucidate the immunopathogenic mechanisms and prognostic factors associated with this association.
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Affiliation(s)
- Meriam Hajji
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia.
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia.
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia.
| | - Imen Gorsane
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Samaraa Badrouchi
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Noureddine Litaiem
- Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Soumaya Rammeh
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Fethi Ben Hamida
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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Whittall-Garcia L, Gladman DD, Urowitz MB, Touma Z, Johnson SR. Correspondence on "relationship between the EULAR/ACR classification criteria and organ damage in systemic lupus erythematosus" by Chi Chiu Mok et al. Lupus 2023; 32:810-811. [PMID: 37125665 DOI: 10.1177/09612033231171365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Laura Whittall-Garcia
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Dafna D Gladman
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Murray B Urowitz
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Zahi Touma
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - 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, ON, Canada
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Mok CC, Chung YK, Lee C, Ho LY, To CH. Relationship between the EULAR/ACR classification criteria and organ damage in systemic lupus erythematosus. Lupus 2023; 32:424-430. [PMID: 36651432 DOI: 10.1177/09612033231153791] [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: 01/19/2023]
Abstract
OBJECTIVES To study the relationship between the 2019 EULAR/ACR classification criteria and organ damage in patients with systemic lupus erythematosus (SLE). METHODS Patients involved in a cross-sectional validation study of the EULAR/ACR criteria and judged by a panel of rheumatologists to be clinical SLE were studied. Those who fulfilled the EULAR/ACR criteria at their last clinic visit were stratified into 2 groups based on a cutoff score of 20. The last SLE International Collaborating Clinic (SLICC) Organ Damage Index (SDI) was compared between these two groups. Relationship among the domains of the EULAR/ACR criteria and SDI in all patients was studied by using Spearman's rank correlation. RESULTS A total of 562 SLE patients were studied (93.6% women; age 36.5 ± 14.1 years; follow-up duration 11.6 ± 6.6 years). The mean and median EULAR/ACR criteria scores in those who fulfilled the EULAR/ACR criteria (N = 542) were 24.6 ± 7.3 and 24 (interquartile range 19-30), respectively. A total of 392 patients had EULAR/ACR scores of ≥20 (group 1), and 150 patients had scores of 10-19 (group 2). Group 1 patients had significantly higher prevalence of fever, alopecia, oral ulcers, acute lupus skin lesions, arthritis, serositis, seizure, hemolytic anemia, leukopenia, and renal disease and so were the anti-dsDNA, anti-Sm, antiphospholipid antibodies, and low complement state. Organ damage (SDI score of ≥1) occurred in 232 (42.8%) patients. Patients in group 1 had significantly higher SDI scores in the renal, cardiovascular, dermatological, and gonadal domains than group 2. The renal, neuropsychiatric, and antiphospholipid antibody domain scores of the EULAR/ACR criteria correlated positively with the total SDI. The renal domain of the EULAR/ACR criteria had the strongest correlation with renal damage (Rho 0.30; p < 0.001). Patients who scored 10 points in the renal domain had significantly higher renal damage score than those scored 8 points or 4 points. Gonadal damage score was also significantly more common in the 10-point than in the 8-point group. CONCLUSION In addition to disease classification, the EULAR/ACR SLE criteria may have value in predicting prognosis.
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Affiliation(s)
- Chi Chiu Mok
- Departments of Medicine, 36658Tuen Mun Hospital, Hong Kong, China
| | - Yuen Kwan Chung
- Departments of Medicine, 260246Pok Oi Hospital, Hong Kong, China
| | - Carolyn Lee
- Departments of Medicine, 260246Pok Oi Hospital, Hong Kong, China
| | - Ling Yin Ho
- Departments of Medicine, 36658Tuen Mun Hospital, Hong Kong, China
| | - Chi Hung To
- Departments of Medicine, 260246Pok Oi Hospital, Hong Kong, China
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Heming M, Müller-Miny L, Rolfes L, Schulte-Mecklenbeck A, Brix TJ, Varghese J, Pawlitzki M, Pavenstädt H, Kriegel MA, Gross CC, Wiendl H, Meyer zu Hörste G. Supporting the differential diagnosis of connective tissue diseases with neurological involvement by blood and cerebrospinal fluid flow cytometry. J Neuroinflammation 2023; 20:46. [PMID: 36823602 PMCID: PMC9951507 DOI: 10.1186/s12974-023-02733-w] [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: 07/26/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Neurological manifestations of autoimmune connective tissue diseases (CTD) are poorly understood and difficult to diagnose. We here aimed to address this shortcoming by studying immune cell compositions in CTD patients with and without neurological manifestation. METHODS Using flow cytometry, we retrospectively investigated paired cerebrospinal fluid (CSF) and blood samples of 28 CTD patients without neurological manifestation, 38 CTD patients with neurological manifestation (N-CTD), 38 non-inflammatory controls, and 38 multiple sclerosis (MS) patients, a paradigmatic primary neuroinflammatory disease. RESULTS We detected an expansion of plasma cells in the blood of both N-CTD and CTD compared to non-inflammatory controls and MS. Blood plasma cells alone distinguished the clinically similar entities N-CTD and MS with high discriminatory performance (AUC: 0.81). Classical blood monocytes indicated higher disease activity in systemic lupus erythematosus (SLE) patients. Surprisingly, immune cells in the CSF did not differ significantly between N-CTD and CTD, while CD4+ T cells and the CD4+/CD8+ ratio were elevated in the blood of N-CTD compared to CTD. Several B cell-associated parameters partially overlapped in the CSF in MS and N-CTD. We built a machine learning model that distinguished N-CTD from MS with high discriminatory power using either blood or CSF. CONCLUSION We here find that blood flow cytometry alone surprisingly suffices to distinguish CTD with neurological manifestations from clinically similar entities, suggesting that a rapid blood test could support clinicians in the differential diagnosis of N-CTD.
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Affiliation(s)
- Michael Heming
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Louisa Müller-Miny
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Leoni Rolfes
- grid.14778.3d0000 0000 8922 7789Department of Neurology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andreas Schulte-Mecklenbeck
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Tobias J. Brix
- grid.5949.10000 0001 2172 9288Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Julian Varghese
- grid.5949.10000 0001 2172 9288Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Marc Pawlitzki
- grid.14778.3d0000 0000 8922 7789Department of Neurology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Hermann Pavenstädt
- grid.16149.3b0000 0004 0551 4246Division of General Internal Medicine, Nephrology and Rheumatology, Department of Medicine D, University Hospital of Münster, Münster, Germany
| | - Martin A. Kriegel
- grid.5949.10000 0001 2172 9288Department of Translational Rheumatology and Immunology, Institute of Musculoskeletal Medicine, University of Münster, Münster, Germany ,grid.16149.3b0000 0004 0551 4246Section of Rheumatology and Clinical Immunology, Department of Medicine, University Hospital Münster, Münster, Germany
| | - Catharina C. Gross
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Heinz Wiendl
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Gerd Meyer zu Hörste
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
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11
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Whittall-Garcia L, Gladman DD, Urowitz MB, Su J, Touma Z, Johnson SR. The New EULAR/ACR 2019 SLE Classification Criteria: A predictor of long-term outcomes. Semin Arthritis Rheum 2022; 57:152103. [DOI: 10.1016/j.semarthrit.2022.152103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 10/14/2022]
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12
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Duarte-García A, Hocaoglu M, Valenzuela-Almada M, Osei-Onomah SA, Dabit JY, Sanchez-Rodriguez A, Duong SQ, Giblon RE, Langenfeld HE, Alarcón GS, Helmick CG, Crowson CS. Rising incidence and prevalence of systemic lupus erythematosus: a population-based study over four decades. Ann Rheum Dis 2022; 81:1260-1266. [PMID: 35577385 PMCID: PMC10481386 DOI: 10.1136/annrheumdis-2022-222276] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/05/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine the trends in incidence, prevalence and mortality of systemic lupus erythematosus (SLE) in a US population over four decades. METHODS We identified all the patients with SLE in Olmsted County, Minnesota who fulfilled the European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) criteria for SLE during 1976-2018. Age-specific and sex-specific incidence and prevalence rates were adjusted to the standard 2000 projected US population. The EULAR/ACR score was used as a proxy for disease severity. Standardised mortality ratio (SMR) was estimated. RESULTS There were 188 incident SLE cases in 1976-2018 (mean age 46.3±SD 16.9; 83% women). Overall age-adjusted and sex-adjusted annual SLE incidence per 100 000 population was 4.77 (95% CI 4.09 to 5.46). Incidence was higher in women (7.58) than men (1.89). The incidence rate increased from 3.32 during 1976-1988 to 6.44 during 2009-2018. Incidence rates were higher among the racial and ethnic minority populations than non-Hispanic whites. The EULAR/ACR score did not change significantly over time. Overall prevalence increased from 30.6 in 1985 to 97.4 in 2015. During the study period, there was no improvement in SMR over time (p=0.31). CONCLUSIONS The incidence and prevalence of SLE are increasing in this US population. The increase in incidence may be at least partially explained by the rising ethnic/racial diversity of the population. There was no evidence that the severity of SLE has changed over time. The survival gap between SLE and the general population remains unchanged. As the US population grows more diverse, we might continue to see an increase in the incidence of SLE.
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Affiliation(s)
- Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehmet Hocaoglu
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, USA
| | | | | | - Jesse Y Dabit
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Stephanie Q Duong
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, New York, USA
| | - Rachel E Giblon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, New York, USA
| | - Hannah E Langenfeld
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, New York, USA
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, New York, USA
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13
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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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14
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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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15
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Insfrán CE, Aikawa NE, Pasoto SG, Filho DMN, Formiga FFC, Pitta AC, Borba EF, Ribeiro CT, Silva CA, Bonfa E. 2019-EULAR/ACR classification criteria domains at diagnosis: predictive factors of long-term damage in systemic lupus erythematosus. Clin Rheumatol 2021; 41:1079-1085. [PMID: 34782939 DOI: 10.1007/s10067-021-05989-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/09/2021] [Accepted: 11/08/2021] [Indexed: 12/28/2022]
Abstract
The objective of this study is to assess the role of the 2019-European League Against Rheumatism/American College of Rheumatology (2019-EULAR/ACR) classification criteria at diagnosis and its domains in predicting long-term damage in systemic lupus erythematosus(SLE). We performed a retrospective analysis using an electronic chart database utilized in routine clinical care of SLE patients and established in 2000 in a tertiary hospital. Two hundred and nine consecutive SLE patients with disease onset ≥18 years old and long disease duration were included. Cumulative damage at the last visit was scored using the SLICC/ACR-Damage Index (SDI). The median age at SLE diagnosis was 28 years (18-63), disease duration was 14 years (8-25), and 88% were females. Damage (SDI≥1) was observed in 116/209 (55%). Patients with (SDI≥1, n=116) and without damage (SDI=0, n=93) had similar median disease duration [14 (8-25) vs. 12 (8-25) years, p=0.090] and age at diagnosis [23 (18-55) vs. 23 (18-56) years, p=0.998]. No correlation was observed between total 2019-EULAR/ACR score at diagnosis and SDI at last visit (r=0.007, p=0.913). Presence of renal domain at diagnosis was associated with renal damage at last visit (OR=3.6, 95%CI 1.2-10.4, p=0.017) and antiphospholipid antibodies domain predicted neuropsychiatric damage (OR=3.0, 95%CI 1.2-7.6, p=0.015). A ROC analysis identified that a cut-off >24 in 2019-EULAR/ACR score could predict a trend for renal damage (p=0.077) with a lower renal survival (Kaplan-Meier curve) for patients above this limit (p=0.029). A multivariate logistic regression analysis revealed that 2019-EULAR/ACR score >24 at diagnosis (OR 4.583, 95%CI 1.052-19.962, p=0.043) was independently associated with renal damage. Specific domains in the 2019-EULAR/ACR criteria at diagnosis were associated with long-term organ-specific damage, particularly renal and neuropsychiatric harm. A 2019-EULAR/ACR score >24 predicted worse renal survival. Key Points • Presence of renal domain of the 2019-EULAR/ACR classification criteria at diagnosis was associated with long-term renal damage. • Presence of antiphospholipid antibodies domain at diagnosis was associated with long-term neuropsychiatric damage. • A 2019-EULAR/ACR overall score >24 at diagnosis was independently associated with renal damage and predicted worse renal long-term survival.
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Affiliation(s)
- Carlos E Insfrán
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Nadia E Aikawa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Dilson M N Filho
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Francisco F C Formiga
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Ana C Pitta
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Carolina T Ribeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Clovis A Silva
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil.
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16
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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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17
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Whittall-Garcia L, Gladman DD, Urowitz M, Su J, Touma Z, Johnson SR. Response to: Correspondence on "New EULAR/ACR 2019 SLE classification criteria: defining ominosity in SLE" by Whittall Garcia et al. Ann Rheum Dis 2021:annrheumdis-2021-221014. [PMID: 34344704 DOI: 10.1136/annrheumdis-2021-221014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Laura Whittall-Garcia
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Murray Urowitz
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jiandong Su
- Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada
| | - Zahi Touma
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sindhu R Johnson
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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18
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Pons-Estel GJ, Ugarte-Gil MF, Harvey GB, Pons-Estel BA, Alarcón GS. Correspondence on "New EULAR/ACR 2019 SLE classification criteria: defining ominosity in SLE" by Whittall Garcia et al. Ann Rheum Dis 2021:annrheumdis-2021-220994. [PMID: 34344707 DOI: 10.1136/annrheumdis-2021-220994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 01/30/2023]
Affiliation(s)
- Guillermo J Pons-Estel
- Departament of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina
| | - Manuel F Ugarte-Gil
- Rheumatology, Hospital Guillermo Almenara Irigoyen. EsSalud, Lima, Peru.,Universidad Científica del Sur, Lima, Peru
| | - Guillermina B Harvey
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - Bernardo A Pons-Estel
- Departament of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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19
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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: 10] [Impact Index Per Article: 3.3] [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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