First Diagnosis of Systemic Lupus Erythematosus in Hospitalized Patients: Clinical Phenotypes and Pitfalls for the Non-Specialist

Kapsala, Noemin; Nikolopoulos, Dionysis; Flouda, S.; Chavatza, Aikaterini P; Tseronis, D.; Aggelakos, M.; Katsimbri, Pelagia; Βertsias, George; Fanouriakis, Antonis; Boumpas, Dimitrios T.

doi:10.1016/j.amjmed.2021.07.015

Cited by 12 publications

(5 citation statements)

References 44 publications

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“… 22 An observational cohort study found that among the 191 hospitalised patients due to manifestations eventually attributed to SLE, although 79.5% of them were diagnosed within 3 months from hospitalisation, the diagnosis was delayed in 39 patients, particularly those with haematological manifestations. 3 Our data revealed that SLERPI enabled earlier diagnosis in some patients compared with the clinical diagnosis and EULAR/ACR-2019 criteria, especially in patients with important organ involvement, such as the kidney and haematological system. Therefore, the use of SLERPI in clinical practice may lead to more timely interventions for patients with SLE and contribute to improved patient prognosis.…”

Section: Discussionmentioning

confidence: 63%

“…The new classification criteria are developed to improve the sensitivity and specificity, and the early discrimination of the classification criteria is also particularly important for SLE. 3 The present study evaluated the performance of SLERPI in a Chinese cohort and revealed that SLERPI has good diagnostic efficacy, particularly for the earlier identification of SLE.…”

Section: Discussionmentioning

confidence: 89%

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Systemic Lupus Erythematosus Risk Probability Index: ready for routine use? Results from a Chinese cohort

Zhang,

Lu,

Yan

et al. 2023

Lupus Sci Med

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ObjectivesTo evaluate the performance of Systemic Lupus Erythematosus Risk Probability Index (SLERPI) in patients with SLE using a Chinese cohort.MethodsThe Chinese cohort included 352 patients with and 385 without SLE (control group). The clinical data of patients, including demographic data, clinical findings and serological profiles, were collected. Patients with an SLERPI score >7 were classified as SLE. The performance of the American College of Rheumatology (ACR)-1997, Systemic Lupus International Collaborating Clinics (SLICC)-2012 and European League Against Rheumatism (EULAR)/ACR-2019 criteria were used as references.ResultsOf these four classification criteria, SLERPI has the highest sensitivity (98.3% (95% CI 96.3% to 99.4%)), but lowest specificity (89.4% (95% CI 85.8% to 92.2%)). In the control group, patients eligible for the classification criteria for SLE were mainly those with primary Sjogren’s syndrome (pSS) and undifferentiated connective tissue disease (UCTD), which adversely affected the specificity of the classification criteria. Moreover, significantly more patients with pSS and UCTD met SLERPI than those who met other classification criteria. After excluding patients with pSS and UCTD from the control group, the specificity and accuracy of SLERPI improved to 94.3% (95% CI 91.0% to 96.6%) and 96.5% (95% CI 95.0% to 97.9%), respectively, and both outperformed the EULAR/ACR-2019 criteria. The time to SLERPI classification was the same as their clinical time to diagnosis in 261 patients, earlier than the clinical diagnosis in 23 patients and later than the clinical diagnosis in 9 patients. A total of 280 patients had the same time to SLERPI classification as EULAR/ACR-2019, 8 patients had earlier than EULAR/ACR-2019 and 1 patient had later than EULAR/ACR-2019.ConclusionSLERPI performed well in patients with SLE, particularly for the earlier diagnosis of SLE.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 89%

Systemic Lupus Erythematosus Risk Probability Index: ready for routine use? Results from a Chinese cohort

Zhang,

Lu,

Yan

et al. 2023

Lupus Sci Med

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“…There are several classification criteria (1997 ACR, 2012 SLICC, and 2019 ACR/EULAR) for approaching the diagnosis of SLE; however, these criteria fail to classify up to 20% of cases. 4 The SLERPI was created with the aim of improving the approach to this condition, achieving an accuracy of up to 94.2% for the diagnosis of SLE, including early and severe disease.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown that the SLERPI scale has a sensitivity of 88.8%-97.6% for the diagnosis of SLE, demonstrating better performance than other clinical scales such as ACR/EU-LAR or SLICC. 4,5 The SLERPI scale is found superior to other scales in identifying SLE in undifferentiated connective tissue disease, enabling early management and potentially reducing complications. 6 While medical judgment is considered the gold standard for the diagnosis and classification of this disease, different regression predictive models allow for the early identification of SLE, potentially impacting early management and the prognosis of the condition.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the SLE Risk Probability Index (SLERPI) scale against the European League Against Rheumatism/American College of Rheumatology (ACR/EULAR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria

Castañeda-González,

Mogollón Hurtado,

Rojas-Villarraga

et al. 2024

Lupus

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Introduction Timely diagnosis and proper recognition of Systemic Lupus Erythematosus (SLE) is essential to establish early management in inpatients and outpatients. There are different classification scales to identify SLE, which include various clinical and serological aspects. In 2021, the SLE Risk Probability Index (SLERPI) was published, which focuses predominantly on the clinical characteristics of patients with suspected SLE and uses a simple algorithm for early recognition of the disease. The aim of this study is to compare the European League Against Rheumatism/American College of Rheumatology (ACR/EULAR) classification criteria, the Systemic Lupus International Collaborating Clinics (SLICC) criteria, and the SLERPI criteria in a cohort of Colombian patients with SLE and to analyze the correlations observed between their absolute scores. Methods A registry of SLE patients from two referral hospitals in Bogotá, Colombia, was used. 2021 SLERPI, 2019 ACR/EULAR, and 2012 SLICC scores were calculated for each patient and the correlations found between the scales were analyzed. The sensitivities of each were compared, and frequency analyses were conducted among different clinical and laboratory variables. Results Between 2016 and 2019, 146 patients diagnosed with SLE were registered, including inpatients and outpatients. The median age was 36 years (interquartile range 26–51), and 82.2% were women. According to the SLERPI criteria, a high prevalence of antinuclear antibodies (92%), immunological disorders (71%), and arthritis (64%) were observed. The most used treatments were corticosteroids (87.6%) and chloroquine (67.8%). A Spearman evaluation analysis was performed, with a moderately strong correlation of 0.76 ( p = .000) between the SLERPI and ACR/EULAR scales and very strong correlation of 0.80 ( p = .000) between the SLERPI and SLICC. Patients classified with SLE according to the SLERPI scale exhibited a higher incidence of hematological compromise, along with elevated levels of serological markers such as anti-DNA antibodies. Additionally, this group more commonly received treatments involving corticosteroids and azathioprine, and displayed a higher prevalence of hypertension. Conclusion The SLERPI scale could be useful in the diagnosis of SLE, especially in early stages, given its good correlation with other classification scales and its good sensitivity.

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“…However, in the case of male geriatric patients, the diagnosis is often overlooked due to the low incidence and atypical manifestations of the disease. Fewer than 10% of patients may first present with a single, generalized (often severe) manifestation from one organ system, such as the kidneys or central nervous system (organ-dominant disease) [ 6 ]. Out of all the solid organs involved, renal involvement in SLE is one of the most common and feared manifestations of this disease as it is related to high morbidity and increased mortality rate, especially in lupus nephritis (LN), which is a highly specific finding [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Systemic Lupus Erythematosus in the Elderly That Debuts With an Organic Manifestation of Lupus Nephritis

Khan¹,

Sawant²,

Deen³

et al. 2022

Cureus

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Systemic lupus erythematosus (SLE) is a systemic autoimmune condition with many clinical presentations. It is classically seen in young to middle-aged females and can present with cutaneous, renal, serosal, hematological, joint, and/or neurological manifestations at the time of diagnosis or may develop over the course of the disease. Late-onset SLE or SLE in the elderly is a subtype that differs from the classic SLE in age group, clinical presentation, involvement of organs, and severity. Here, we present the case of a geriatric Hispanic male noted to have worsening renal function. The patient was diagnosed with lupus nephritis (LN) upon obtaining serological markers and renal biopsy. LN, a renal sequela of SLE, presents with a full-house immunofluorescence pattern. LN, along with high titers of the antinuclear antibody (ANA) and/or anti-double-stranded DNA (anti-dsDNA) antibody, is an effective tool to diagnose SLE in patients without extrarenal manifestations of the disease. The patient was managed with glucocorticoids and mycophenolate mofetil therapy, which led to a rapid downtrend of creatinine, resulting in stabilization of renal function and deferring the need for a hemodialysis. This case highlights the topic of late-onset SLE presenting with LN in geriatric patients.

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First Diagnosis of Systemic Lupus Erythematosus in Hospitalized Patients: Clinical Phenotypes and Pitfalls for the Non-Specialist

Cited by 12 publications

References 44 publications

Systemic Lupus Erythematosus Risk Probability Index: ready for routine use? Results from a Chinese cohort

Systemic Lupus Erythematosus Risk Probability Index: ready for routine use? Results from a Chinese cohort

Comparison of the SLE Risk Probability Index (SLERPI) scale against the European League Against Rheumatism/American College of Rheumatology (ACR/EULAR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria

Systemic Lupus Erythematosus in the Elderly That Debuts With an Organic Manifestation of Lupus Nephritis

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