In an early SLE cohort the ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria classify non-overlapping groups of patients: use of all three criteria ensures optimal capture for clinical studies while their modification earlier classification and treatment.
Objectives: Classification criteria are biased towards classifying long-standing disease. We compared the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR)-2019, Systemic Lupus International Collaborating Clinics (SLICC)-2012 and ACR-1997 criteria in an early (median...
| Publicado en: | Annals of the Rheumatic Diseases Vol. 79; no. 2; pp. 232 - 242 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Elsevier B.V.
Feb2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=141523182&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 141523182 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00034967 ANR jtl: Annals of the Rheumatic Diseases issn: 00034967 maglogo: N pubinfo: dt: Feb2020 vid: 79 iid: 2 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 141523182 141523182 NLM31704720 141523182 10.1136/annrheumdis-2019-216155 NLM31704720 141523182 ppf: 232 ppct: 10 formats: tig: atl: In an early SLE cohort the ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria classify non-overlapping groups of patients: use of all three criteria ensures optimal capture for clinical studies while their modification earlier classification and treatment. aug: au: Adamichou, Christina Nikolopoulos, Dionysis Genitsaridi, Irini Bortoluzzi, Alessandra Fanouriakis, Antonis Papastefanakis, Emmanouil Kalogiannaki, Eleni Gergianaki, Irini Sidiropoulos, Prodromos Boumpas, Dimitrios T. Bertsias, George K. affil: Department of Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Greece sug: subj: Severity of Illness Indices Lupus Erythematosus, Systemic Classification Rheumatology Methods Lupus Erythematosus, Systemic Diagnosis Symptoms Diagnosis Middle Age Female Sensitivity and Specificity Rheumatology Standards Retrospective Design Adult Algorithms Male Human Validation Studies Comparative Studies Evaluation Research Multicenter Studies Middle Aged: 45-64 years Adult: 19-44 years Female Male ab: Objectives: Classification criteria are biased towards classifying long-standing disease. We compared the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR)-2019, Systemic Lupus International Collaborating Clinics (SLICC)-2012 and ACR-1997 criteria in an early (median 48 months) systemic lupus erythematosus (SLE) cohort.Methods: Patients diagnosed with SLE (n=690) or control diseases (n=401). Sensitivity, specificity of the criteria and time-to-classification were calculated. Modified classification algorithms were derived from a random 80% and validated in the remaining 20% of the dataset running multiple iterations.Results: At last assessment, sensitivities of ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria were 85.7%, 91.3% and 88.6%, with specificities 93.0%, 93.8% and 97.3%, respectively. Both SLICC and EULAR/ACR enabled earlier classification. Only 76.7% of patients with SLE met all three criteria suggesting non-overlapping groups. Notably, unclassified patients had high prevalence of British Isles Lupus Assessment Group moderate/severe manifestations (43.3%-60%) and SLICC/ACR organ damage (30%-50%). At diagnosis, criteria missed 25.6%-30.5% of patients. Modification of EULAR/ACR and SLICC algorithms to include hypocomplementaemia and/or positive anti-phospholipid antibodies as alternative entry criterion, and/or allow classification with fewer clinical criteria from multiple organs, increased their sensitivity at diagnosis (median 82.0% and 86.2%) and overall (93.7% and 97.1%) with modest decreases in specificity. Importantly, patients who were still missed by the modified criteria had lower incidence of major organ involvement, use of immunosuppressive/biological therapies and organ damage.Conclusions: The SLICC and EULAR/ACR are more sensitive than the ACR and the EULAR/ACR criteria have superior specificity in early SLE, although patients with significant disease can be missed. Combination and/or modification of the classification algorithms may enhance their sensitivity, allowing earlier classification and treatment of more patients with high disease burden. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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