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Diagnostic Criteria for SLE: ACR’97 vs SLICC’12

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Veronica Hackethal, MD

Aug 3, 2018

ACR’97, 1997 American College of Rheumatology criteria; EULAR, European League Against Rheumatism; SLE, systemic lupus erythematosus; SLICC’12, 2012 Systemic Lupus International Collaborating Clinics criteria.

It's probably better to read the following at the links below.

Based on sensitivity and specificity, the SLICC’12 criteria are best for adult SLE and the ACR’97 criteria are best for juvenile SLE, assuming avoiding false-positives outweighs avoiding false-negatives. Neither the SLICC’12 criteria nor the ACR’97 criteria should be used alone for diagnosis: not fulfilling the criteria does not exclude SLE from the differential.

A comprehensive diagnostic scheme combining ACR’97 and SLICC’12 criteria has been proposed for early recognition of SLE with major organ involvement.2 EULAR is working on defining new SLE criteria.

Hartman and fellow researchers in the Netherlands and Austria conducted a meta-analysis to compare the 2012 Systemic Lupus International Collaborating Clinics criteria (SLICC’12) with the revised American College of Rheumatology criteria from 1997 (ACR’97).1 Their objective: to assess the ability of these criteria to classify systemic lupus erythematosus (SLE) in adult and juvenile patients.

Here I present the highlights of their study, including the implications for clinical practice.

ACR’97, 1997 American College of Rheumatology criteria; SLE, systemic lupus erythematosus; SLICC’12, 2012 Systemic Lupus International Collaborating Clinics criteria.

There is no “gold standard” for SLE diagnosis; the revised ACR’97 classification criteria for SLE are most frequently used. The SLICC’12 criteria were drawn up because of concern over redundant/lacking items in the ACR’97 criteria. Noteworthy differences in the SLICC’12 criteria include a wider spectrum of clinical manifestations; sufficiency of biopsy-proven nephritis and positive serology for diagnosis; reorganization of mucocutaneous manifestation items; and merging of photosensitivity and malar rash.

ACR’97, 1997 American College of Rheumatology criteria; SLE, systemic lupus erythematosus; SLICC’12, 2012 Systemic Lupus International Collaborating Clinics criteria.

A systematic literature search was conducted using PubMed and Embase from 2012 onward, limited to English-only studies.1 The sensitivity and specificity of the ACR’97 and SLICC’12 criteria were evaluated.

ACR’97, 1997 American College of Rheumatology criteria; SLE, systemic lupus erythematosus; SLICC’12, 2012 Systemic Lupus International Collaborating Clinics criteria.

In adults with SLE, the SLICC’12 criteria have higher sensitivity and similar specificity compared with the ACR’97 criteria. For juvenile SLE, the ACR’97 criteria have higher specificity than the SLICC’12 criteria, although the SLICC’12 criteria have higher sensitivity and classify patients earlier in their disease course than the ACR’97 criteria.1 Individual items that contribute to diagnostic accuracy are low complement, anti-ds DNA and acute cutaneous lupus in the SLICC’12 criteria, and immunologic and hematologic disorders in the ACR’97 criteria.

ACR’97, 1997 American College of Rheumatology criteria; EULAR, European League Against Rheumatism; SLE, systemic lupus erythematosus; SLICC’12, 2012 Systemic Lupus International Collaborating Clinics criteria.

Based on sensitivity and specificity, the SLICC’12 criteria are best for adult SLE and the ACR’97 criteria are best for juvenile SLE, assuming avoiding false-positives outweighs avoiding false-negatives. Neither the SLICC’12 criteria nor the ACR’97 criteria should be used alone for diagnosis: not fulfilling the criteria does not exclude SLE from the differential.

A comprehensive diagnostic scheme combining ACR’97 and SLICC’12 criteria has been proposed for early recognition of SLE with major organ involvement.2 EULAR is working on defining new SLE criteria.

Hartman and fellow researchers in the Netherlands and Austria conducted a meta-analysis to compare the 2012 Systemic Lupus International Collaborating Clinics criteria (SLICC’12) with the revised American College of Rheumatology criteria from 1997 (ACR’97).1 Their objective: to assess the ability of these criteria to classify systemic lupus erythematosus (SLE) in adult and juvenile patients.

References

1. Hartman EAR, van Royen-Kerkhof A, Jacobs JWG, et al. Performance of the 2012 Systemic Lupus International Collaborating Clinics classification criteria versus the 1997 American College of Rheumatology classification criteria in adult and juvenile systemic lupus erythematosus. A systematic review and meta-analysis. Autoimmun Rev. 2018;17:316-322. doi: 10.1016/j.autrev.2018.01.007.

2. Bertsias GK, Pamfil C, Fanouriakis A, et al. Diagnostic criteria for systemic lupus erythematosus: has the time come? Nat Rev Rheumatol. 2013;9:687-694. doi: 10.1038/nrrheum.2013.103.

Source: rheumatologynetwork.com/lup...

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