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Papachristodoulou E, Graef E, Magliulo D, Kyttaris V. Prevalence and clinical significance of lymphadenopathy and its histological subtypes in patients with systemic lupus erythematosus: a retrospective cohort study. Rheumatol Int 2023; 43:1277-1286. [PMID: 37097329 DOI: 10.1007/s00296-023-05331-4] [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: 04/17/2023] [Indexed: 04/26/2023]
Abstract
The objective of this study was to evaluate the prevalence and the clinical significance of lymphadenopathy and its histological subtypes in patients with systemic lupus erythematosus. We conducted a retrospective cohort study of patients with SLE diagnosed using the 1997 ACR criteria, who were followed at our institution between 2008 and 2022. Patients were grouped based on the presence of SLE-attributed LAD and its histological phenotype, then compared in terms of demographic, clinical and laboratory characteristics. Of the 255 patients, 33.7% had SLE-attributed, 0.8% lymphoma-related and 0.4% tuberculosis-related LAD. Univariate analysis identified significant associations between the presence of LAD and fever (p < 0.0001), weight loss (p = 0.009), pericarditis (p = 0.004), myocarditis (p = 0.003), myositis (p = 0.034), leukopenia (p = 0.004), lymphopenia (p = 0.003), membranous nephritis (p = 0.004), anti-RNP (p = 0.001), anti-Smith (p = < 0.0001), and SSB antibodies (p = 0.038), and hypocomplementemia (C3:p = 0.019; C4:p < 0.0001). Logistic regression confirmed the associations of LAD with fever (OR = 3.277, 95% C.I 1.657-6.481), pericarditis (OR = 4.146, 95% C.I:1.577-10.899), membranous nephritis (OR = 3.586, 95% C.I:1.305-9.854), and leukopenia (OR = 2.611, 95%C.I:1.319-5.166), but not with weight loss, myocarditis, or myositis. Biopsy in a subset of patients (33.7% of total) revealed reactive/proliferative (62.1%) or necrotizing (37.9%) histological patterns. When we compared the histologic patterns, necrotizing LAD was associated with fever (p = 0.052), sicca (p = 0.018), and malar rash (p = 0.005). Most patients received corticosteroids, hydroxychloroquine, and/or DMARDs with relatively quick clinical improvement. In conclusion, LAD is a common SLE manifestation, associated with constitutional symptoms, myo-/pericarditis, myositis, cytopenia, and membranous nephritis. Despite relatively high prevalence of LAD in SLE, a biopsy may still be needed to rule out lymphoma.
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Affiliation(s)
- Eleni Papachristodoulou
- Division of Rheumatology, Beth Israel Deaconess Medical Center, 110 Francis St, Suite 4B, Boston, MA, 02215, USA
| | - Elizabeth Graef
- Division of Rheumatology, Beth Israel Deaconess Medical Center, 110 Francis St, Suite 4B, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston University, Boston, MA, USA
| | - Daniel Magliulo
- Division of Rheumatology, Beth Israel Deaconess Medical Center, 110 Francis St, Suite 4B, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Vasileios Kyttaris
- Division of Rheumatology, Beth Israel Deaconess Medical Center, 110 Francis St, Suite 4B, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
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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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Eudy AM, Rogers JL, Corneli A, McKenna K, Maheswaranathan M, Pisetsky DS, Criscione-Schreiber LG, Doss J, Sadun RE, Sun K, Clowse MEB. Intermittent and Persistent Type 2 lupus: patient perspectives on two distinct patterns of Type 2 SLE symptoms. Lupus Sci Med 2022; 9:9/1/e000705. [PMID: 36927502 PMCID: PMC9362789 DOI: 10.1136/lupus-2022-000705] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We have developed a new conceptual model to characterise the signs and symptoms of SLE: the Type 1 and 2 SLE Model. Within the original model, Type 1 SLE consists of inflammatory manifestations like arthritis, nephritis and rashes; Type 2 SLE includes symptoms of fatigue, myalgia, mood disturbance and cognitive dysfunction. Through in-depth interviews, we explored how the Type 1 and 2 SLE Model fits within the lived experience of patients with SLE, with a focus on the connection between Type 1 and Type 2 SLE symptoms. METHODS Semistructured in-depth interviews were conducted among adult participants meeting 1997 American College of Rheumatology or Systemic Lupus International Collaborating Clinics criteria for SLE. Participants were purposefully selected for age, race, sex and nephritis history. All interviews were audio-recorded and transcribed. Data were analysed through episode profile and thematic analysis. RESULTS Through interviews with 42 patients with SLE, two patterns of Type 2 SLE emerged: Intermittent (n=18) and Persistent (n=24). Participants with Intermittent Type 2 SLE described feeling generally well when Type 1 is inactive; these participants were younger and had more internal SLE manifestations. Participants with Persistent Type 2 described always experiencing Type 2 symptoms despite inactive Type 1, although the severity may fluctuate. Participants with Persistent Type 2 SLE experienced traditional lupus symptoms of joint pain, hair loss and rash, but less often had severe organ system involvement. CONCLUSIONS By listening to the stories of our patients, we found two underlying patterns of Type 2 SLE: Intermittent Type 2 symptoms that resolve in synchrony with Type 1 inflammatory symptoms, and Persistent Type 2 symptoms that continue despite remission of Type 1 symptoms.
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Affiliation(s)
- Amanda M Eudy
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer L Rogers
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin McKenna
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mithu Maheswaranathan
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David S Pisetsky
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | | | - Jayanth Doss
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca E Sadun
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kai Sun
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan E B Clowse
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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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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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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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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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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Abstract
PURPOSE OF REVIEW To review the validation of the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 classification criteria for systemic lupus erythematosus (SLE). RECENT FINDINGS Positive antinuclear antibodies, which constitute the obligatory entry criterion of the EULAR/ACR criteria, were found in the vast majority of SLE patients worldwide, with 97% (94-100%) of patients antinuclear antibodies positive in studies investigating EULAR/ACR criteria performance. Combined over the publications, EULAR/ACR criteria sensitivity was 92% (range 85-97%). Specificity varied more relevantly, with the publications published after the EULAR/ACR 2019 criteria showing 93% (83-98%) specificity. Of particular relevance is the good performance of the EULAR/ACR criteria seen in pediatric SLE as well as in early SLE. SUMMARY The new classification criteria have been investigated in an impressive number of cohorts worldwide, adding to the data from the EULAR/ACR criteria project cohort. It is critical to strictly keep to the attribution rule, that items are only counted if there is no more likely alternative explanation than SLE, the domain structure, where only the highest weighted item in a domain counts, and the limitation to highly specific tests for antibodies to double-stranded DNA.
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Affiliation(s)
- Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, 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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Wang H, Gao Y, Ma Y, Cai F, Huang X, Lan L, Ren P, Wang Y, Chen J, Han F. Performance of the 2019 EULAR/ACR systemic lupus erythematosus classification criteria in a cohort of patients with biopsy-confirmed lupus nephritis. Lupus Sci Med 2021; 8:e000458. [PMID: 33558437 PMCID: PMC7871694 DOI: 10.1136/lupus-2020-000458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the performance of the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) SLE classification criteria in a cohort of patients with biopsy-confirmed lupus nephritis (LN) and their renal prognosis. METHODS Patients with newly diagnosed SLE attending and followed up for >12 months were included. A retrospective review of all patients with renal biopsy fulfilling a consensus expert opinion during 2014 and 2018. Clinical, serological and pathological data were collected and each patient was assigned a high/low criteria scores (HS/LS) group. Survival curves for flare adjusted for multiplicity on renal flares, was applied to the two groups. RESULTS Applying EULAR/ACR criteria in our cohort of 126 patients, 6 (4.76%) did not meet the criterion, resulting in a sensitivity of 95.24%. The EULAR/ACR criteria scores was positively correlated with SLE disease activity index scores. Additionally, we noticed that a significant difference in clinical and immunological manifestations between HS and LS group. We observed a higher proportions of class Ⅲ or Ⅳ LN and lower proportions of class Ⅱ or V LN (p=0.034) and pathological higher activity index in HS group (p=0.007). Compared with LS groups, patients involved more severe renal damage and achieved higher rate of complete remission in the HS group. The Kaplan-Meier exploratory analyses, adjusted for LN classification, estimated glomerular filtration rate, activity index and chronicity index and induction and maintenance treatments, showed that patients in the HS group had a tendency of higher renal flare risk than that in the LS group (HR=0.21, p=0.04). CONCLUSIONS The EULAR/ACR criteria performed high sensitivity in identifying SLE in this cohort of biopsy-confirmed LN. Patients with LN with high criteria scores had more extrarenal manifestations, and worse renal prognosis in the short and long terms.
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Affiliation(s)
- Huijing Wang
- Kidney Disease Center, Zhejiang University School of Medicine First Affiliated Hospital; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China
| | - Yunjie Gao
- Kidney Disease Center, Zhejiang University School of Medicine First Affiliated Hospital; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China
| | - Yanhong Ma
- Kidney Disease Center, Zhejiang University School of Medicine First Affiliated Hospital; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China
| | - Fanghao Cai
- Kidney Disease Center, Zhejiang University School of Medicine First Affiliated Hospital; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China
| | - Xiaohan Huang
- Kidney Disease Center, Zhejiang University School of Medicine First Affiliated Hospital; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China
| | - Lan Lan
- Kidney Disease Center, Zhejiang University School of Medicine First Affiliated Hospital; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China
| | - Pingping Ren
- Kidney Disease Center, Zhejiang University School of Medicine First Affiliated Hospital; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China
| | - Yaomin Wang
- Kidney Disease Center, Zhejiang University School of Medicine First Affiliated Hospital; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China
| | - Jianghua Chen
- Kidney Disease Center, Zhejiang University School of Medicine First Affiliated Hospital; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China
| | - Fei Han
- Kidney Disease Center, Zhejiang University School of Medicine First Affiliated Hospital; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China
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Batu ED, Akca UK, Kısaarslan AP, Sağ E, Demir F, Demir S, Çiçek SÖ, Poyrazoglu H, Sozeri B, Bilginer Y, Ozen S. The Performances of the ACR 1997, SLICC 2012, and EULAR/ACR 2019 Classification Criteria in Pediatric Systemic Lupus Erythematosus. J Rheumatol 2020; 48:907-914. [DOI: 10.3899/jrheum.200871] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/14/2022]
Abstract
Objective.Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. The American College of Rheumatology (ACR) 1997, Systemic Lupus International Collaborating Clinics (SLICC) 2012, and European League Against Rheumatism (EULAR)/ACR 2019 SLE classification criteria are formed based on data mainly from adult patients. We aimed to test the performances of the SLE classification criteria among pediatric patients with SLE.Methods.Pediatric patients with SLE (n = 262; 80.9% female) were included from 3 different centers in Turkey. As controls, 174 children (60.9% female) with other diseases who had ANA (antinuclear antibody) test results were included. The gold standard for SLE diagnosis was expert opinion.Results.The sensitivities of the ACR 1997, SLICC 2012, and EULAR/ACR 2019 criteria were 68.7%, 95.4%, and 91.6%, respectively. The specificities of the ACR 1997, SLICC 2012, and EULAR/ACR 2019 criteria were 94.8%, 89.7%, and 88.5%, respectively. Eighteen patients with SLE met the SLICC 2012 but not the EULAR/ACR 2019 criteria. Among these, hematologic involvement was prominent (n = 13; 72.2%). Eight patients with SLE fulfilled the EULAR/ACR 2019 but not the SLICC 2012 criteria. Among these, joint involvement was prominent (n = 6; 75%).Conclusion.To our knowledge, this is the largest cohort study of pediatric SLE to test the performances of all 3 classification criteria. The SLICC 2012 criteria yielded the best sensitivity, whereas the ACR 1997 criteria had the best specificity. SLICC 2012 criteria performed better than EULAR/ACR 2019 criteria. Separation of different hematological manifestations in the SLICC 2012 criteria might have contributed to the higher performance of this criteria set.
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