A comparison of the sensitivity of the 1971 and 1982 american rheumatism association criteria for the classification of systemic lupus erythematosus

Abstract

The sensitivity of the American Rheumatism Association's preliminary and revised criteria for the classification of systemic lupus erythematosus (SLE) was tested in 156 of our SLE patients. Eighty-eight percent met the 1971 preliminary criteria. Eighty-three percent fulfilled the 1982 revised criteria when arthritis was strictly defined (nonerosive arthritis) and 91 9' 0 when arthritis was more liberally defined (nondeforming arthritis). Analysis revealed that of the 3 serologic tests added in the revised criteria (antinuclear antibody, antiSm, anti-DNA), the antinuclear antibody test accounted for the increased sensitivity of the revised criteria.The American Rheumatism Association (ARA) revised criteria for the classification of systemic lupus erythematosus (SLE) have recently been published (1). The ARA preliminary criteria for the classification of systemic lupus erythematosus had been in use since publication in 1971 (2); the revision was considered necessary in order to add newer laboratory tests such as anti-DNA and antinuclear antibody (ANA) and to regroup laboratory tests and clinical findings into specific sets so as to increase the specificity and sensitivity of the preliminary criteria. Although many studies have been reported on testing of the preliminary criteria, no such studies have been reported on the revised criteria. We have therefore tested the revised criteria on our own group of SLE patients, in order to evaluate sensitivity and compare it with that of the preliminary criteria.The results of our study reveal that the revised criteria are minimally more sensitive than the preliminary criteria and that the addition of the antinuclear antibody manifestation is the major contributor to this increased sensitivity. PATIENTS AND METHODSPatients. Outpatients or hospitalized patients followed by faculty members of the Division of Rheumatic Diseases during the period January 1, 1980 through December 31, 1982 at the University of Connecticut Health Center were considered for study. Patients were considered by their physician to have SLE, based on the presence of multisystern disease considered to be compatible with SLE. The diagnosis of SLE was made by the faculty member whether or not the patient fulfilled the preliminary criteria.Data entry and analysis. Data on the 156 patients were reviewed and information entered into a database booklet by the fellow and/or faculty member caring for the patient. Data entered by fellows were checked by the faculty member who had been responsible for the patient. The database booklet listed the 36 elements of the 2 sets of criteria exactly as defined in the literature (Tables 1 and 2).For each element, the reviewer entered one of the following: "yes," "no," "unclear," or "unknown." "Unclear" entries were reviewed by one of the authors (NFR) and were

Application, to Japanese patients, of the 1982 American Rheumatism Association revised criteria for the classification of systemic lupus erythematosus

“…Among items which were added to the revised criteria, FANA was found to contribute most to an increase in sensitivity. A similar result was reported by Levin et a1 (4).…”

Increased Frequency of Pre-germinal Center B Cells and Plasma Cell Precursors in the Blood of Children with Systemic Lupus Erythematosus

“…All pediatric SLE patients included in this study fulfil the established American College of Rheumatology criteria for SLE (31). The patients' clinical and serological data were gathered during clinic visits, and the corresponding SLE disease activity index (SLEDAI) was recorded in the chart (32).…”

Epidemiologi ved systemisk lupus erythematosus (SLE)

“…For å tilfredsstille klassifikasjonskriteriene må en pasient ha 4 eller flere ACRkriterier enten på samme tid eller over tid. Kriteriene av 1971 hadde 88% sensitivitet og 91% spesifisitet og kriteriene av 1982 96% sensitivitet og spesifisitet når de ble anvendt på en gruppe av 245 SLE-pasienter og en kontrollgruppe bestående av 234 pasienter med rheumatoid athritt og 217 andre (7).…”