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Lerkvaleekul B, Chobchai P, Rattanasiri S, Vilaiyuk S. Evaluating performance of the 2019 EULAR/ACR, 2012 SLICC, and 1997 ACR criteria for classifying adult-onset and childhood-onset systemic lupus erythematosus: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1093213. [PMID: 36619627 PMCID: PMC9813386 DOI: 10.3389/fmed.2022.1093213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The American College of Rheumatology (ACR) 1997, Systemic Lupus International Collaborating Clinics (SLICC) 2012, and European League Against Rheumatism (EULAR)/ACR 2019 SLE criteria are often used to classify patients with adult-onset and childhood-onset systemic lupus erythematosus (SLE) in clinical practice because there are currently no diagnostic criteria for SLE. However, there is scarce evidence regarding which criteria are best for diagnosing patients with adult-onset and childhood-onset SLE. Methods We searched Medline and Scopus databases for English-language articles from inception through October 2021. Data were extracted from the included publications by two independent reviewers. We performed bivariate meta-analysis with a random-effects model to pool diagnostic parameters. Meta-regression and subgroup analyses were performed to explore heterogeneity sources. We used network meta-analysis to compare diagnosis performance among the three criteria and ranked them in descending order. Publication bias was assessed using Deeks' funnel plot. Results We included 29 studies for systematic review and meta-analysis. Of these, 18 studies involved adult-onset SLE and 11 studies involved childhood-onset SLE. The pooled sensitivities of the three criteria for diagnosis of adult-onset SLE were comparable between SLICC 2012 and EULAR/ACR 2019 [95.86, 95% confidence interval (CI) 92.28-97.81 vs. 94.79, 95% CI 92.03-96.63]; pooled specificity was highest in ACR 1997 (92.24, 95% CI 87.06-95.46). In childhood-onset SLE, pooled sensitivity was highest in SLICC 2012 (93.76, 95% CI 89.45-96.39), and pooled specificity was highest in ACR 1997 (95.89, 95% CI 91.73-98.00). In network meta-analysis, the pooled diagnostic odds ratio ranked highest for EULAR/ACR 2019 (131.570, 95% CI 61.50-281.47) in adult-onset SLE and ranked highest for SLICC 2012 (191.07, 95% CI 76.06-480.01) in childhood-onset SLE. Deeks' funnel plot showed no publication bias. Conclusion We found that the diagnostic performance of the ACR 1997, SLICC 2012, and EULAR/ACR 2019 criteria differed between adult-onset and childhood-onset SLE. EULAR/ACR 2019 performed best for adult-onset SLE and SLICC 2012 was best for childhood-onset SLE in classifying patients with SLE. Systematic review registration [www.ClinicalTrials.gov], identifier [CRD420 21281586].
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Affiliation(s)
- Butsabong Lerkvaleekul
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pantira Chobchai
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Soamarat Vilaiyuk
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,*Correspondence: Soamarat Vilaiyuk,
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Lu W, Tian F, Ma J, Zhong Y, Liu Z, Xue L. Diagnostic accuracy of the European League against rheumatism/American College of Rheumatology-2019 versus the Systemic Lupus International Collaborating Clinics-2012 versus the ACR-1997 classification criteria in adult systemic lupus erythematosus: A systematic review and meta-analysis. Front Immunol 2022; 13:1023451. [PMID: 36311745 PMCID: PMC9599400 DOI: 10.3389/fimmu.2022.1023451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/28/2022] [Indexed: 12/04/2022] Open
Abstract
Aim To evaluate the diagnostic performance of the American College of Rheumatology (ACR)-1997, the Systemic Lupus International Collaborating Clinics (SLICC)-2012, and the European League against Rheumatism (EULAR)/ACR-2019 classification criteria in adult patients with systemic lupus erythematosus (SLE). Methods PubMed, Embase, Web of Science and Cochrane Library databases were searched for literature comparing the three classification criteria of ACR-1997, SLICC-2012 and EULAR/ACR-2019, which took clinical diagnosis as reference. Meta-analysis was used to evaluate and compare the sensitivity, specificity and diagnostic odds ratio of ACR-1997, SLICC-2012 and EULAR/ACR-2019. To assess the early diagnosis capability of the classification criteria, subgroups of patients with disease duration < 3 years and < 1 year were selected for comparison of sensitivity and specificity based on the inclusion of the original study. The sensitivity and specificity of each item in three sets of classification criteria were evaluated. In addition, the clinical and immunological characteristics of patients who did not meet the three classification criteria were compared. Results Nine original studies were included in the analysis, including 6404 SLE patients and 3996 controls. Results showed that the diagnostic odds ratios (95% confidence interval) of the SLICC-2012 [136.35 (114.94, 161.75)] and EULAR/ACR-2019 [187.47 (158.00, 222.42)] were higher than those of the ACR-1997 [67.53 (58.75, 77.63)]. Compared with ACR-1997[(0.86 (0.82, 0.89)], SLICC-2012[(0.96 (0.93, 0.97)] and EULAR/ACR-2019[(0.95 (0.92, 0.97)] had higher sensitivity. The specificity of the three classification criteria was similar: ACR-1997, SLICC-2012, and EULAR/ACR-2019 were 0.93 (0.89, 0.95), 0.86 (0.79, 0.91), and 0.91 (0.85, 0.95), respectively. The sensitivity of SLICC-2012 and EULAR/ACR-2019 were higher than that of ACR-1997 in early-course subgroups. Patients who did not meet ACR-1997 had more hypocomplementemia, patients who did not meet SLICC-2012 had more cutaneous lupus and photosensitivity, and patients who did not meet EULAR/ACR-2019 had more cutaneous lupus and leucopenia. Conclusions SLICC-2012 and EULAR/ACR-2019 have better diagnostic ability than the ACR-1997, and the sensitivity of the former two criteria is also higher than that of the latter; Moreover, the SLICC-2012 and EULAR/ACR-2019 for patients in the early stages of disease performed equally excellent.
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Affiliation(s)
- Wentian Lu
- Department of Hematology, Huzhou Central Hospital, Affiliated Huzhou Hospital Zhejiang University School of Medicine, Huzhou, China
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Fengmei Tian
- Nursing Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinlu Ma
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Zhong
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhichun Liu
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Leixi Xue, ; Zhichun Liu,
| | - Leixi Xue
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Leixi Xue, ; Zhichun Liu,
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Lu W, Zhong Y, Weng C, Wang Q, Tang M, Liu Z, Xue L. Utility of the ACR-1997, SLICC-2012 and EULAR/ACR-2019 classification criteria for systemic lupus erythematosus: a single-centre retrospective study. Lupus Sci Med 2022. [PMCID: PMC9462103 DOI: 10.1136/lupus-2022-000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aims Several different versions of classification criteria, including the American College of Rheumatology (ACR)-1997, Systemic Lupus International Collaborating Clinics (SLICC)-2012 and European Alliance of Associations for Rheumatology (EULAR)/ACR-2019 classification criteria, have been launched in the past decades. The current study aimed to investigate the performance of these three classification criteria for diagnosing patients with SLE in a Chinese cohort. Methods 352 patients with SLE and 385 controls with other diseases who had the detection results of ANA were enrolled into the study. Various clinical parameters were estimated, such as demographics variables, clinical characteristics and other variables related to three criteria. Results The current study demonstrated great diagnostic ability of the three criteria; and the receiver operating characteristic curve and the area under curve (AUC) were used to evaluate the diagnostic ability of three criteria: ACR-1997 (AUC=0.972), SLICC-2012 (AUC=0.986) and EULAR/ACR-2019 (AUC=0.983). Despite lower specificity of the SLICC-2012 and EULAR/ACR-2019 classification criteria, their sensitivity is significantly improved than ACR-1997. Of note, we also compared the median time interval between the appearance of the earliest item and fulfilment of the three sets of criteria, suggesting the SLICC-2012 and EULAR/ACR-2019 could achieve earlier diagnosis. Adjusting the thresholds of the EULAR/ACR-2019 criteria from 10 to 12, the specificity and accuracy significantly increased. Conclusion The SLICC-2012 and EULAR/ACR-2019 performed well in Chinese patients with SLE and showed better early diagnosis ability. In addition, by adjusting the classification threshold, the accuracy of the EULAR/ACR-2019 classification criteria was improved.
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Affiliation(s)
- Wentian Lu
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ying Zhong
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chenghua Weng
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qing Wang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Mei Tang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhichun Liu
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Leixi Xue
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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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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Chung YK, Ho LY, Lee C, To CH, Mok CC. Validation of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in ANA-positive Chinese patients. Ther Adv Musculoskelet Dis 2022; 14:1759720X221100300. [PMID: 35651982 PMCID: PMC9150246 DOI: 10.1177/1759720x221100300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to validate the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for systemic lupus erythematosus (SLE) in antinuclear antibody (ANA)-positive Chinese patients. Methods: Medical records of all adult patients who attended the rheumatology out-patient clinics between May and September 2019 were reviewed. Patients with ever ANA positive (titre ⩾1:80) were included and evaluated for the fulfilment of the 2019 EULAR/ACR, 2012 Systemic Lupus International Collaborating Clinics (SLICC) and 1997 ACR criteria for SLE classification. The performance of these criteria in predicting a clinical diagnosis of SLE as judged by an independent panel of rheumatologists was studied and compared in different subgroups. Results: A total of 1533 patients (88.2% women; age at first clinic attendance 45.5 ± 15.6 years) were studied and 562 patients were judged to be clinical SLE. The sensitivity and specificity of the EULAR/ACR (⩾10 points), SLICC and ACR criteria for a clinical diagnosis of SLE was 96.1%, 97.9% and 86.1%; and 85.8%, 86.3% and 94.3%, respectively. Applying the attribution rule to the non-SLE controls, the specificity of the three criteria increased to 95.0%, 92.5% and 98.8%, respectively. The specificity of the EULAR/ACR criteria was higher in male patients (97.9%), those aged >50 years (97.0%) and disease duration of ⩽3 years (97.6%). Using a cut-off of 12 points, the specificity of the EULAR/ACR criteria was further increased (96.6%) while a high sensitivity (95.0%) was maintained. Conclusion: In Chinese patients with a positive ANA, the EULAR/ACR criteria for clinical SLE perform equally well to the SLICC criteria. Both the EULAR/ACR and SLICC are more sensitive but less specific than the ACR criteria. The specificity of all the three criteria is enhanced by applying the attribution rule to controls. The specificity of the EULAR/ACR criteria is higher in certain patient subgroups or when the cut-off score is raised.
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Affiliation(s)
- Yuen Kwan Chung
- Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, China
| | - Ling Yin Ho
- Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, China
| | - Carolyn Lee
- Department of Medicine, Pok Oi Hospital, Yuen Long, Hong Kong SAR, China
| | - Chi Hung To
- Department of Medicine, Pok Oi Hospital, Yuen Long, Hong Kong SAR, China
| | - Chi Chiu Mok
- Chief of Rheumatology, Department of Medicine, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong SAR, China
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Evaluation of the European League Against Rheumatism/American College of Rheumatology-2019 classification criteria in patients with childhood-onset systemic lupus erythematosus: a single-center retrospective study. Clin Rheumatol 2022; 41:2483-2489. [PMID: 35377008 DOI: 10.1007/s10067-022-06138-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 12/12/2022]
Abstract
This study aimed to compare the sensitivity and specificity of the European League Against Rheumatism/American College of Rheumatology-2019 (EULAR/ACR-2019) classification criteria with prior classification schemes for patients with childhood-onset systemic lupus erythematosus (cSLE). This single-center retrospective study examined 53 patients with cSLE and 53 patients having antinuclear antibody (ANA) titers ≥ 1:80 but not cSLE as controls. Sensitivity and specificity were calculated for the EULAR/ACR-2019 criteria, original criteria reported earlier in 2019, the ACR-1997 criteria, and the Systemic Lupus International Collaborating Clinics-2012 (SLICC-2012) criteria. The frequency of positivity in the cSLE group for each item of the EULAR/ACR-2019, ACR-1997, and SLICC-2012 criteria was determined. Characteristics of the misclassified patients were also investigated. All patients with cSLE had ANA titers ≥ 1:80. The non-SLE diagnoses included juvenile idiopathic inflammatory myopathies, primary Sjögren's syndrome (pSS), juvenile idiopathic arthritis, systemic sclerosis, mixed connective tissue disease (MCTD), and others. Sensitivities of the EULAR/ACR-2019 criteria, the original criteria, the ACR-1997 criteria, and the SLICC-2012 criteria were 100%, 100%, 86.8%, and 100%, respectively; the specificities were 84.9%, 92.5%, 98.1%, and 88.7%, respectively. In the cSLE group, the items of the SLE-specific antibody (100%), complement (98.1%), hematological (94.3%), and renal (84.9%) domains were frequently observed in the EULAR/ACR-2019 criteria. The EULAR/ACR-2019 criteria misclassified patient controls more frequently, especially those with MCTD or pSS, as having SLE than the previous criteria. The EULAR/ACR-2019 criteria for cSLE had high sensitivity but low specificity; the weighted scoring of the original criteria reported earlier in 2019 may confer higher specificity and be more appropriate for the classification of SLE in a pediatric population. Key Points • The EULAR/ACR-2019 criteria for cSLE had high sensitivity but low specificity. • The EULAR/ACR-2019 criteria more frequently misclassified non-SLE patients who did not have SLE, especially those with MCTD or pSS, as having SLE than the previous criteria in patients with childhood onset. • The weighted scoring of the original criteria reported earlier in 2019 may confer higher specificity and be a more appropriate classification of SLE for a pediatric population.
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Aringer M, Alarcón-Riquelme ME, Clowse M, Pons-Estel GJ, Vital EM, Dall’Era M. A glimpse into the future of systemic lupus erythematosus. Ther Adv Musculoskelet Dis 2022; 14:1759720X221086719. [PMID: 35368371 PMCID: PMC8972918 DOI: 10.1177/1759720x221086719] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/23/2022] [Indexed: 12/17/2022] Open
Abstract
This viewpoint article on a forecast of clinically meaningful changes in the management of systemic lupus erythematosus (SLE) in the next 10 years is based on a review of the current state of the art. The groundwork has been laid by a robust series of classification criteria and treatment recommendations that have all been published since 2019. Building on this strong foundation, SLE management predictably will take significant steps forward. Assessment for lupus arthritis will presumably include musculoskeletal sonography. Large-scale polyomics studies are likely to unravel more of the central immune mechanisms of the disease. Biomarkers predictive of therapeutic success may enter the field; the type I interferon signature, as a companion for use of anifrolumab, an antibody against the common type I interferon receptor, is one serious candidate. Besides anifrolumab for nonrenal SLE and the new calcineurin inhibitor voclosporin in lupus nephritis, both of which are already approved in the United States and likely to become available in the European Union in 2022, several other approaches are in advanced clinical trials. These include advanced B cell depletion, inhibition of costimulation via CD40 and CD40 ligand (CD40L), and Janus kinase 1 (Jak1) and Tyrosine kinase 2 (Tyk2) inhibition. At the same time, essentially all of our conventional therapeutic armamentarium will continue to be used. The ability of patients to have successful SLE pregnancies, which has become much better in the last decades, should further improve, with approaches including tumor necrosis factor blockade and self-monitoring of fetal heart rates. While we hope that the COVID-19 pandemic will soon be controlled, it has highlighted the risk of severe viral infections in SLE, with increased risk tied to certain therapies. Although there are some data that a cure might be achievable, this likely will remain a challenge beyond 10 years from now.
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Affiliation(s)
- Martin Aringer
- Professor of Medicine (Rheumatology), Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine, TU Dresden, 01307 Dresden, Germany
| | - Marta E. Alarcón-Riquelme
- Department of Medical Genomics, GENYO, Pfizer-University of Granada-Andalusian Government Center for Genomics and Oncological Research, Granada, Spain
| | - Megan Clowse
- Division of Rheumatology & Immunology, Duke University, Durham, NC, USA
| | - Guillermo J. Pons-Estel
- Department of Rheumatology, Grupo Oroño–Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Edward M. Vital
- University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Maria Dall’Era
- Lupus Clinic and Rheumatology Clinical Research Center, Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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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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Inoue Y, Ogura T, Yamashita N, Takenaka S, Ito H, Hirata A, Katagiri T, Takakura Y, Imaizumi C, Mizushina K, Imamura M, Kujime R, Hayashi N, Kameda H. Performance of the Revised Classification Criteria for Systemic Autoimmune Rheumatic Diseases and Their Overlap Syndromes. Intern Med 2022; 61:1947-1952. [PMID: 35781270 PMCID: PMC9334226 DOI: 10.2169/internalmedicine.8487-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective We evaluated the performance of the revised classification criteria for assessing different systemic autoimmune rheumatic diseases and their overlap syndromes. Methods A total of 652 patients with or highly suspected of having systemic lupus erythematosus (SLE), systemic sclerosis (SSc), polymyositis (PM)/dermatomyositis (DM) or rheumatoid arthritis (RA) were included in this study. The 1997 revised American College of Rheumatology (ACR) and the 2019 European League Against Rheumatism (EULAR)/ACR criteria for SLE, the 1980 ACR and the 2013 ACR/EULAR criteria for SSc, the criteria by Bohan and Peter and the 2017 EULAR/ACR criteria for PM/DM, and the 1987 revised ACR and 2011 ACR/EULAR criteria for RA were used for disease classification. Results The old and new criteria and a clinical diagnosis were used to respectively classify 103, 106 and 105 SLE patients; 35, 47 and 58 SSc patients; 18, 23 and 33 PM/DM patients; and 297, 389 and 468 RA patients. Sensitivity increased from 82.9% to 92.4% in SLE, from 56.9% to 79.3% in SSc, from 54.5% to 66.7% in PM/DM, and from 62.6% to 80.8% in RA. SLE-SSc was the predominant type of clinical overlap syndrome, while SLE-RA was the most classifiable. Conclusion The revised classification criteria for all the diseases showed an improved sensitivity, and SLE-overlap syndrome was predominant, regardless of the criteria sets.
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Affiliation(s)
- Yuki Inoue
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | - Takehisa Ogura
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | - Naoko Yamashita
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | - Sayaka Takenaka
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | - Hideki Ito
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | - Ayako Hirata
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | - Takaharu Katagiri
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | - Yuto Takakura
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | - Chihiro Imaizumi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Kennosuke Mizushina
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | - Munetsugu Imamura
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | - Rie Kujime
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
| | | | - Hideto Kameda
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Japan
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Kheyri Z, Laripour A, Ala M. Peritonitis as the first presentation of systemic lupus erythematous: a case report. J Med Case Rep 2021; 15:611. [PMID: 34953487 PMCID: PMC8710242 DOI: 10.1186/s13256-021-03216-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022] Open
Abstract
Background Systemic lupus erythematosus is an inflammatory disease affecting several organs. Serositis is one of the systemic lupus erythematosus presentations, but peritonitis is a relatively rare presentation. Particularly, it is extremely rare to observe peritonitis as the first presentation of systemic lupus erythematosus. Case presentation Here, we present a case of peritonitis without other symptoms of systemic lupus erythematosus, in a patient who was finally diagnosed with systemic lupus erythematosus. Our patient was a 27-year-old Persian/Caucasian male with fatigue, weakness, weight loss, abdominal distension, massive ascites, and normocytic hemolytic anemia. He did not mention any prior medical conditions and did not use any drugs. There were no signs of thyroid dysfunction, cardiac dysfunction, cancers, infectious diseases, hepatitis, kidney diseases, or other diseases. Low-gradient, high-protein ascites fluid, and positive antinuclear antibody and anti-double stranded DNA were in favor of systemic lupus erythematosus. Corticosteroid pulse therapy led to resolution of ascites, and the patient was discharged with prednisolone and hydroxychloroquine. Conclusion Peritonitis is a rare presentation of systemic lupus erythematosus, particularly as the first presentation and in the absence of other signs and symptoms; however, systemic lupus erythematosus should be considered as one the differential diagnoses for peritonitis when other etiologies have been ruled out.
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Affiliation(s)
- Zahedin Kheyri
- Baharloo Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Gastroenterology, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amirreza Laripour
- Students' Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - Moein Ala
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Selvananda S, Kan SL. Performance of the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus in a multiethnic Malaysian cohort. Int J Rheum Dis 2021; 25:131-139. [PMID: 34939743 DOI: 10.1111/1756-185x.14269] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/19/2022]
Abstract
AIM To evaluate the performance of the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for systemic lupus erythematosus (SLE) in a multi-ethnic Malaysian cohort and to compare it against the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and ACR 1997 criteria. METHOD We conducted a retrospective observational study of 205 patients with a diagnosis of SLE and 100 controls who formed the validation cohort. The sensitivity and specificity of the three classification criteria were evaluated and a further sub-analysis was performed in patients with early disease and among the various ethnicities. RESULTS The sensitivities and specificities of the three classification criteria are as follows: EULAR/ACR (90.8%; 94%), SLICC 2012 (96.1%; 94%), and ACR 1997 (82%; 96%). Among patients with early disease, the sensitivity of the SLICC 2012 was higher than that of EULAR/ACR and ACR 1997 (98% vs 94% and 86%); however, the specificity of EULAR/ACR and ACR 1997 were similar (95.2%) and higher than the SLICC 2012 (93.5%). The SLICC 2012 had higher sensitivity than that of the EULAR/ACR among the Malays (94% vs 90%), Chinese (98% vs 90%), and Indians (100% vs 95%). The specificity of the EULAR/ACR and SLICC 2012 were similar in the Malay and Chinese (93.3% each, and 92% vs 94.6%). CONCLUSION The EULAR/ACR performed well in our cohort. The EULAR/ACR and SLICC 2012 showed higher sensitivity than the ACR 1997, and the EULAR/ACR showed similar specificity to the ACR 1997 and SLICC 2012 overall, in early disease, and across the different ethnicities.
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Affiliation(s)
- Shakira Selvananda
- Rheumatology Unit, Department of Internal Medicine, Penang General Hospital, Penang, Malaysia
| | - Sow Lai Kan
- Rheumatology Unit, Department of Internal Medicine, Penang General Hospital, Penang, Malaysia
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Mok CC, Hamijoyo L, Kasitanon N, Chen DY, Chen S, Yamaoka K, Oku K, Li MT, Zamora L, Bae SC, Navarra S, Morand EF, Tanaka Y. The Asia-Pacific League of Associations for Rheumatology consensus statements on the management of systemic lupus erythematosus. THE LANCET. RHEUMATOLOGY 2021; 3:e517-e531. [PMID: 38279404 DOI: 10.1016/s2665-9913(21)00009-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
Systemic lupus erythematosus (SLE) is prevalent in Asia and carries a variable prognosis among patients across the Asia-Pacific region, which could relate to access to health care, tolerability of medications, and adherence to therapies. Because many aspects of SLE are unique among patients from this region, the Asia-Pacific League of Associations for Rheumatology developed the first set of consensus recommendations on the management of SLE. A core panel of 13 rheumatologists drafted a set of statements through face-to-face meeting and teleconferences. A literature review was done for each statement to grade the quality of evidence and strength of recommendation. 29 independent specialists and three patients with SLE were then recruited for a modified Delphi process to establish consensus on the statements through an online voting platform. A total of 34 consensus recommendations were developed. Panellists agreed that patients with SLE should be referred to a specialist for the formulation of a treatment plan through shared decision making between patients and physicians. Remission was agreed to be the goal of therapy, but when it cannot be achieved, a low disease activity state should be aimed for. Patients should be screened for renal disease, and hydroxychloroquine is recommended for all Asian people with SLE. Major organ manifestations of SLE should be treated with induction immunosuppression and subsequently maintenance; options include cyclophosphamide, mycophenolate mofetil, azathioprine, and calcineurin inhibitors, in combination with glucocorticoids. Biologics, combination regimens, plasma exchange, and intravenous immunoglobulins should be reserved for cases of refractory or life-threatening disease. Anticoagulation therapy with warfarin is preferred to the direct oral anticoagulants for thromboembolic SLE manifestations associated with a high-risk antiphospholipid antibody profile.
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Affiliation(s)
- Chi Chiu Mok
- Division of Rheumatology, Department of Medicine, Tuen Mun Hospital, Hong Kong Special Administrative Region, China.
| | - Laniyati Hamijoyo
- Rheumatology Division, Department of Internal Medicine, Padjadjaran University, Jawa Barat, Indonesia
| | - Nuntana Kasitanon
- Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Thailand
| | - Der Yuan Chen
- Rheumatology and Immunology Centre, China Medical University, Taichung, Taiwan
| | - Sheng Chen
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Meng Tao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China; Chinese Academy of Medical Science, National Clinical Research Centre for Dermatological and Immunological Diseases, Beijing, China
| | - Leonid Zamora
- Section of Rheumatology, University of Santo Tomas, Manila, Philippines
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Sandra Navarra
- Section of Rheumatology, University of Santo Tomas, Manila, Philippines
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University School of Clinical Sciences, Monash Medical Centre, Melbourne, Australia
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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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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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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Xu J, Chen G, Yan Z, Qiu M, Tong W, Zhang X, Zhang L, Zhu Y, Liu K. Effect of mannose-binding lectin gene polymorphisms on the risk of rheumatoid arthritis: Evidence from a meta-analysis. Int J Rheum Dis 2021; 24:300-313. [PMID: 33458965 PMCID: PMC7986746 DOI: 10.1111/1756-185x.14060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/25/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The effect of mannose-binding lectin (MBL) gene polymorphisms on susceptibility of rheumatoid arthritis (RA) were evaluated in ethnically different populations, whereas the results were always inconsistent. MATERIALS AND METHODS Fourteen articles involving 36 datasets were recruited to evaluate the association between MBL gene polymorphisms and rheumatoid arthritis in a meta-analysis. The random or fixed effect models were used to evaluate the pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). RESULTS Stratified analysis by ethnicities was conducted and the result revealed that rs1800450 (T vs C, OR = 1.32, 95% CI: 1.04-1.67, P < .05) and MBL-A/O (T vs C, OR = 1.20, 95% CI: 1.08-1.34, P < .001) were strongly associated with RA in Brazilian populations. In addition, the significant relationship between rs11003125 (T vs C, OR = 1.16, 95% CI: 1.06-1.26, P < .05) with RA were also observed in East Asian populations. Meanwhile, the inverse associations between rs5030737 with RA in East Asians and rs1800450 with RA in Indians were acquired. However, no association between any MBL polymorphism with RA susceptibility was confirmed in Caucasians. CONCLUSIONS The structural polymorphisms in exon 1 of MBL gene may significantly contribute to susceptibility and development of RA in Brazilian and Indian populations, whereas the functional polymorphisms in the promoter region were more likely to associate with RA in East Asians.
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Affiliation(s)
- Jinjian Xu
- School of Public HealthSun Yat‐Sen UniversityGuangzhouChina
- Department of Epidemiology and BiostatisticsSchool of Public HealthZhejiang UniversityHangzhouChina
| | - Gang Chen
- Affiliated Dongtai Hospital of Nantong UniversityDongtaiChina
| | - Zhen Yan
- Gaoxin Hospital of The First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Mochang Qiu
- Department of Clinical MedicineJiangxi Medical CollegeShangraoChina
| | - Wentao Tong
- Jingdezheng NO.1 People’s HospitalJingdezhenChina
| | | | - Li Zhang
- Department of Clinical MedicineJiangxi Medical CollegeShangraoChina
| | - Yimin Zhu
- Department of Epidemiology and BiostatisticsSchool of Public HealthZhejiang UniversityHangzhouChina
| | - Keqi Liu
- Department of Clinical MedicineJiangxi Medical CollegeShangraoChina
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