The American College of Rheumatology and the Systemic Lupus International Collaborating Clinics Classification criteria for systemic lupus erythematosus in two multiethnic cohorts: a commentary

Pons-Estel, GJ; Wojdyla, Daniel; McGwin, Gerald; Magder, Larry; Petri, M.; Pons-Estel, B.; Gs, Alarcón

doi:10.1177/0961203313512883

Cited by 65 publications

(65 citation statements)

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“…Possibly the most controversial change brought by the SLICC 2012 is ending the "double counting" of photosensitive malar rash as 2 criteria, as allowed with the ACR 1997 (10,11). In fact, we found this to be the most frequent cause for losing SLE classification by the SLICC 2012 when achieved by the ACR 1997.…”

Section: Discussionmentioning

confidence: 79%

“…On the contrary, a study in the LUMINA and Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohorts showed that the proportion of patients fulfilling the ACR 1997 earlier in the disease course was larger than for the SLICC 2012. However, as noted, this study had no data on several clinical and immunologic manifestations newly included in SLICC 2012 (11).…”

Section: Discussionmentioning

confidence: 96%

“…Nonetheless, in our study this caused a loss of classification with SLICC 2012 in a very small proportion of patients. In a study in the LUpus in MInorities, NAture versus nurture (LUMINA) cohort, the proportion of SLE patients not classified with SLICC 2012 criteria while satisfying the ACR 1997 criteria due to this issue was larger (11). However, it must be noted that fulfilling the ACR 1997 criteria was a precondition to be included in the LUMINA cohort.…”

Section: Discussionmentioning

confidence: 99%

“…This study was not designed to determine which set of criteria allows an earlier SLE classification; an observational longitudinal study of an inception cohort of patients suspected of having lupus and related disorders will be better suited for that. Finally, we did not aim to compare specificity of these classification criteria; the original SLICC 2012 derivation and validation work and subsequent studies suggest that specificity may be better with the ACR 1997 (5,11,12).…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Classification of Systemic Lupus Erythematosus: Systemic Lupus International Collaborating Clinics Versus American College of Rheumatology Criteria. A Comparative Study of 2,055 Patients From a Real‐Life, International Systemic Lupus Erythematosus Cohort

Inês

Silva

Galindo

et al. 2015

Arthritis Care & Research

140

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Objective. The new Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria aimed to improve the performance of systemic lupus erythematosus (SLE) classification over the American College of Rheumatology (ACR) 1997 criteria. However, the SLICC 2012 criteria need further external validation. Our objective was to compare the sensitivity for SLE classification between the ACR 1997 and the SLICC 2012 criteria sets in a real-life, multicenter, international SLE population. Methods. We conducted a cross-sectional observational study of patients with a clinical diagnosis of SLE followed at the participating rheumatology centers and registered in the Portuguese and Spanish national registries. The sensitivity of the 2 classification sets was compared using McNemar's test. The sensitivity of ACR 1997 and SLICC 2012 was further examined in 5 subgroups, defined according to disease duration. Results. We included 2,055 SLE patients (female 91.4%, white 93.5%, mean 6 SD age at disease onset 33.1 6 14.4 years, mean 6 SD age at SLE diagnosis 35.3 6 14.7 years, and mean 6 SD age at the time of the study 47.4 6 14.6 years) from 17 centers. The sensitivity for SLE classification was higher with the SLICC 2012 than with the ACR 1997 (93.2% versus 85.6%; P < 0.0001). Of 296 patients not fulfilling the ACR 1997, 62.8% could be classified with the SLICC 2012. The subgroup of patients with £5 years since disease onset presented the largest difference in sensitivity between the SLICC 2012 and the ACR 1997 (89.3% versus 76.0%; P < 0.0001); this difference diminished with longer disease duration, and it was no longer significant for patients with >20 years of disease duration. Conclusion. The SLICC 2012 criteria were more sensitive than the ACR 1997 criteria in real-life clinical practice in SLE. The SLICC 2012 criteria may allow patients to be classified as having SLE earlier in the disease course.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Classification of Systemic Lupus Erythematosus: Systemic Lupus International Collaborating Clinics Versus American College of Rheumatology Criteria. A Comparative Study of 2,055 Patients From a Real‐Life, International Systemic Lupus Erythematosus Cohort

Inês

Silva

Galindo

et al. 2015

Arthritis Care & Research

140

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“…A large proportion of SCLE (up to 50%) do not fulfill the American College of Rheumatology criteria [2,4,5]. These are the pitfalls associated with the diagnosis of connective tissue diseases which have protean manifestation [6]. This patient presented with an assemblage of cutaneous signs and arthritis without severe systemic involvement.…”

Section: Discussionmentioning

confidence: 99%

Hibernating Lupus

Suzuki¹,

Lateef²

2015

Rheumatology (Sunnyvale)

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We report a case of a 64-year-old Chinese lady, who was admitted for two weeks' history of fever, cough and breathlessness. She was diagnosed with community acquired pneumonia and treated with antibiotics. Her comorbidity includes plaque psoriasis treated with topical steroids and oral methotrexate for 4 years by private physicians. Her symptoms persisted for weeks post-discharge. After workup, a diagnosis of basal interstitial lung disease with restrictive defect likely drug-induced was established. Her methotrexate therapy was switched to phototherapy. However, her psoriatic rashes worsened after phototherapy, thus, treatment was changed to subcutaneous injection of adalimumab. She then developed inflammatory arthritis, dry mouth and worsening dyspnoea and psoriasiform rashes. Repeat spirometry showed worsening of transfer factor (from 76% to 51%). In light of this peculiar development, her previous laboratory investigations performed in the other private hospitals were retrieved. They were remarkable for positive Anti-nuclear antibodies which were of homogenous pattern and high in titre with Anti-Ro/SS-A positivity. Skin biopsy of the lesion displayed typical histology of psoriasis. This clinical scenario describes a case of psoriasis coexisting with "hibernating" lupus which was "awakened" by use of anti-TNF. With an assemblage of cutaneous signs, interstitial lung disease, arthritis without severe systemic involvement together with strong association with anti-Ro/SS-A antibody, subacute cutaneous lupus erythematosus (SCLE) is suspected to be the most likely underlying lupus that remained dormant and smouldering until it was triggered and worsened by the use of adalimumab and phototherapy. These are the pitfalls associated with the diagnosis of connective tissue diseases which have protean manifestation. This is clinically significant as the diagnosis will affect the choice of immunosuppressants and biologics. The learning point is, in clinical practice, incongruity of enigmatic clinical and histo-pathological findings mandate critical scrutiny and second look as starting biologics without a clear clinical picture is potentially harmful.Keywords: Lupus; Anti-TNF; Psoriasis; Interstitial lung disease; Anti-nuclear antibodies Case ReportWe report a case of a 64-year-old Chinese lady, presenting with two weeks' history of cough and breathlessness. At presentation, she was febrile and tachypnoeic. On chest auscultation, there were bilateral lung crepitations. Chest radiograph revealed bilateral pulmonary infiltrates. Her co-morbidity included plaque psoriasis that was treated with topical steroids and oral methotrexate for 4 years by a few private physicians prior to the current admission. Methotrexate was withheld and broad spectrum antibiotics were given for community acquired pneumonia. Her symptoms improved and she was discharged.A few weeks later, upon clinic review, she complained of worsening psoriatic rashes, persistent breathlessness and intermittent dry cough. A high resolution computed tomogra...

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Performance of the 2012 Systemic Lupus International Collaborating Clinics and the 1997 American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus in a Real‐Life Scenario

Amezcua-Guerra

Higuera-Ortiz

Arteaga-García

et al. 2015

Arthritis Care & Research

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The American College of Rheumatology and the Systemic Lupus International Collaborating Clinics Classification criteria for systemic lupus erythematosus in two multiethnic cohorts: a commentary

Abstract: The authors offer some comments on the advantages and possible drawbacks of using the SLICC criteria in longitudinal observational studies and clinical trials after applying and comparing them to the ACR criteria in two multinational, multiethnic lupus cohorts.

Cited by 65 publications

References 15 publications

Classification of Systemic Lupus Erythematosus: Systemic Lupus International Collaborating Clinics Versus American College of Rheumatology Criteria. A Comparative Study of 2,055 Patients From a Real‐Life, International Systemic Lupus Erythematosus Cohort

Classification of Systemic Lupus Erythematosus: Systemic Lupus International Collaborating Clinics Versus American College of Rheumatology Criteria. A Comparative Study of 2,055 Patients From a Real‐Life, International Systemic Lupus Erythematosus Cohort

Hibernating Lupus

Performance of the 2012 Systemic Lupus International Collaborating Clinics and the 1997 American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus in a Real‐Life Scenario

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