Evaluation of the ACR and SLICC classification criteria in juvenile-onset systemic lupus erythematosus: a longitudinal analysis

Lythgoe, Hanna; Morgan, T; Heaf, Eleanor; Lloyd, O; Al‐Abadi, Eslam; Armon, Kate; Bailey, Kathryn; Davidson, Joyce; Friswell, Mark; Gardner-Medwin, J; Haslam, Kirsty; Ioannou, Yiannis; Leahy, Alice; Leone,; Pilkington, C; Rangaraj, Satyapal; Riley, Philip; Tizard, E. Jane; Wilkinson, Nick; Beresford, MW

doi:10.1177/0961203317700484

Cited by 33 publications

(35 citation statements)

References 11 publications

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“…Specificity was not significantly different [19]. The UK juvenile SLE cohort evaluated only sensitivity, and SLICC also were more sensitive than ACR 1997, both at diagnosis (92.9% versus 84.1%, p < 0.001) and at last visit (100% versus 92%, p < 0.001) [20].…”

Section: Discussionmentioning

confidence: 84%

“…Few studies have evaluated the performance of different SLE classification criteria in cSLE, showing variables results. For cSLE, three studies demonstrated that SLICC criteria classify patients earlier than ACR 1997 [18][19][20]. In the multicentre European study by Sag and colleagues, the sensitivity of SLICC was higher (98.7% versus 85.3%, p < 0.001) but specificity was lower (76.6% versus 93.4%, p < 0.001) compared to ACR 1997, at time of diagnosis [18].…”

Section: Discussionmentioning

confidence: 99%

“…SLICC criteria yielded higher sensitivity (97% versus 83%) but lower specificity (84% versus 96%) than ACR 1997 criteria in the original validation set [7]. In subsequent studies in adult and cSLE, SLICC higher sensitivity was also found, especially for early SLE, however, results were conflicting regarding specificity [13][14][15][16][17][18][19][20]. The SLICC criteria have also been criticized because they were derived comparing the expert's decision ("gold standard") with a standardized group of manifestations [6].…”

Section: Introductionmentioning

confidence: 99%

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Comparison among ACR1997, SLICC and the new EULAR/ACR classification criteria in childhood-onset systemic lupus erythematosus

et al. 2019

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Background: To date there are no specific classification criteria for childhood-onset systemic lupus erythematosus (cSLE). This study aims to compare the performance among the American College of Rheumatology (ACR) 1997, the Systemic Lupus International Collaborating Clinics criteria (SLICC) and the new European League Against Rheumatism (EULAR)/ACR criteria, in a cSLE cohort. Methods: We conducted a medical chart review study of cSLE cases and controls with defined rheumatic diseases, both ANA positive, to establish each ACR1997, SLICC and EULAR/ACR criterion fulfilled, at first visit and 1-yearfollow-up. Results: Study population included 122 cSLE cases and 89 controls. At first visit, SLICC criteria had higher sensitivity than ACR 1997 (89.3% versus 70.5%, p < 0.001), but similar specificity (80.9% versus 83.2%, p = 0.791), however performance was not statistically different at 1-year-follow-up. SLICC better scored in specificity compared to EULAR/ACR score ≥ 10 at first visit (80.9% versus 67.4%, p = 0.008) and at 1-year (76.4% versus 58.4%, p = 0.001), although sensitivities were similar. EULAR/ACR criteria score ≥ 10 exhibited higher sensitivity than ACR 1997 (87.7% versus 70.5%, p < 0.001) at first visit, but comparable at 1-year, whereas specificity was lower at first visit (67.4% versus 83.2%, p = 0.004) and 1-year (58.4% versus 76.4%, p = 0.002). A EULAR/ACR score ≥ 13 against a score ≥ 10, resulted in higher specificity, positive predictive value, and cutoff point accuracy. Compared to SLICC, a EULAR/ACR score ≥ 13 resulted in lower sensitivity at first visit (76.2% versus 89.3%, p < 0.001) and 1-year (91% versus 97.5%, p = 0.008), but similar specificities at both assessments. When compared to ACR 1997, a EULAR/ACR total score ≥ 13, resulted in no differences in sensitivity and specificity at both observation periods. Conclusions: In this cSLE population, SLICC criteria better scored at first visit and 1-year-follow-up. The adoption of a EULAR/ACR total score ≥ 13 in this study, against the initially proposed ≥10 score, was most appropriate to classify cSLE. Further studies are necessary to address if SLICC criteria might allow fulfillment of cSLE classification earlier in disease course and may be more inclusive of cSLE subjects for clinical studies.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison among ACR1997, SLICC and the new EULAR/ACR classification criteria in childhood-onset systemic lupus erythematosus

et al. 2019

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“…Other validation studies similarly showed a higher sensitivity and lower specificity of the SLICC compared with the ACR classification, although none of them elaborated on the stand-alone renal criterion. 11,[29][30][31][32][33] Only Ungprasert et al 33 identified 3 patients with SLE among 55 who met SLICC criteria that were classified based on the stand-alone criterion without commenting on their biopsy findings. We conclude that the SLICC classification may perform well as classification and conceivably also as diagnostic criteria for patients with renal biopsy findings consistent with LN, but we suggest reevaluation of the stand-alone renal criterion for clinical and research purposes.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Systemic Lupus International Collaborating Clinics classification criteria in a cohort of patients with full house glomerular deposits

Rijnink

Teng

Kraaij

et al. 2018

Kidney International

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“…To date, there have been only 2 studies comparing the sensitivity and specificity of ACR and SLICC criteria in cSLE 6,7 . More recently, there has been a larger study examining only the sensitivity of the 2 classification criteria 8 . The aim of our study was to determine and compare the sensitivities of ACR and SLICC criteria in cSLE within a large, multiethnic, single-center cohort.…”

mentioning

confidence: 99%

Comparison of Sensitivities of American College of Rheumatology and Systemic Lupus International Collaborating Clinics Classification Criteria in Childhood-onset Systemic Lupus Erythematosus

Tao

Hiraki²,

Levy³

et al. 2019

J Rheumatol

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Objective.Currently there are 2 different classification criteria for systemic lupus erythematosus (SLE): American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC). The aim of this study was to compare the sensitivities of ACR and SLICC criteria in childhood-onset SLE (cSLE) using a large, multiethnic cohort.Methods.We conducted a retrospective study of 722 patients diagnosed with cSLE at The Hospital for Sick Children (SickKids). Prospectively collected data from SickKids’ Lupus Database were reviewed/validated against medical records prior to ACR and SLICC scoring based on cumulative symptoms up to the last visit. Sensitivities were compared using McNemar’s test. Descriptive statistics were used to identify SLE features unique to each set of criteria and autoantibodies not included in either.Results.ACR and SLICC sensitivities were as follows: 92.4% and 96.3% overall (p = 0.001); 82.5% and 91.3% (p = 0.01) in those scored ≤ 1 year from diagnosis; 92.7% and 97.9% (p = 0.02) in those scored 2–3 years from diagnosis. Forty-eight of 55 (87.3%) patients who did not meet ACR criteria met SLICC criteria through SLICC-specific criterion or renal biopsy. Twenty of 27 (74.1%) patients who did not meet SLICC criteria met ACR criteria as a result of photosensitivity (73.9%) and ACR lymphopenia criteria (26.1%). Six of 7 patients (85.7%) who were clinically diagnosed with cSLE but did not meet either SLICC or ACR criteria had anti-Ro antibodies.Conclusion.SLICC criteria were significantly more sensitive than ACR criteria in cSLE classification, especially early in the disease course. Because of the extreme rarity of primary Sjögren syndrome in children, one may consider adding anti-Ro antibodies to the classification criteria for cSLE because they are present in ∼40% of patents with cSLE.

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Evaluation of the ACR and SLICC classification criteria in juvenile-onset systemic lupus erythematosus: a longitudinal analysis

Cited by 33 publications

References 11 publications

Comparison among ACR1997, SLICC and the new EULAR/ACR classification criteria in childhood-onset systemic lupus erythematosus

Comparison among ACR1997, SLICC and the new EULAR/ACR classification criteria in childhood-onset systemic lupus erythematosus

Validation of the Systemic Lupus International Collaborating Clinics classification criteria in a cohort of patients with full house glomerular deposits

Comparison of Sensitivities of American College of Rheumatology and Systemic Lupus International Collaborating Clinics Classification Criteria in Childhood-onset Systemic Lupus Erythematosus

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