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New EULAR/ACR 2019 SLE Classification Criteria: defining ominosity in SLE
  1. Laura P Whittall Garcia1,2,
  2. Dafna D Gladman1,2,
  3. Murray Urowitz1,2,
  4. Zahi Touma1,3,
  5. Jiandong Su2,
  6. Sindhu R Johnson1,3
  1. 1Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
  2. 2Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
  3. 3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Sindhu R Johnson, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada; Sindhu.Johnson{at}


Objective To determine the ominosity of the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) Systemic Lupus Erythematosus Classification Criteria by determining its predictive role for disease severity in the first 5 years following diagnosis.

Methods 867 patients with systemic lupus erythematosus (SLE) from the Toronto Lupus Clinic were included (all first 12 months after SLE diagnosis). The EULAR/ACR criteria score was calculated based on baseline information. To determine disease severity in the first 5 years after diagnosis, adjusted mean SLE Disease Activity Index 2000 (AMS), flares, remission and immunosuppressive treatment were used as outcomes. The Systemic Lupus International Collaborating Clinics (SLICC) registry comprised the validation cohort.

Results Based on receiver operating characteristic analysis, a EULAR/ACR score of 20 was used as a threshold to compare outcomes between groups. In the first 5 years of disease course, patients with a score of ≥20 had higher AMS scores (p<0.001) and were more likely to ever experience a flare (p<0.001). These patients had lower probabilities of achieving remission and higher requirements for immunosuppressives. Results were confirmed in the SLICC validation cohort. Patients with a score of ≥20 had higher AMS during the first 5 years of disease (5.4 vs 3.1% and ≥20 vs <20 respectively, p≤0.001). The score correlated with AMS (r=0.43, p≤0.001) in the same time frame.

Conclusion A EULAR/ACR score of ≥20 is an indicator of ominosity in SLE. Patients with a score of ≥20 were characterised by a more active disease course throughout the first 5 years. These criteria provide prognostic information regarding disease severity in the first 5 years following diagnosis.

  • Systemic lupus erythematosus
  • classification criteria
  • disease severity
  • outcomes
  • prognosis

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Handling editor Josef S Smolen

  • Presented at This work was presented at the American College of Rheumatology Convergence Meeting, November 2020. Whittall-Garcia L, Gladman D, Urowitz M, Su J, Johnson S. The New EULAR/ ACR 2019 SLE Classification Criteria: Defining Ominosity in SLE [abstract]. Arthritis Rheumatol 2020; 72 (suppl 10).

  • Correction notice This article has been corrected since it published Online First. The provenance and peer review statement has been included.

  • Contributors All authors contributed to the study design, data collection and/or evaluation and critical review of the final manuscript.

  • Funding Support for this study came from the Lupus Program, Centre for Prognosis Studies in the Rheumatic Diseases. SRJ is supported by a Canadian Institutes of Health Research Award. ZT is supported by a research salary award from the Department of Medicine, University of Toronto.

  • Competing interests SRJ reports grants from Bayer, Boehringer Ingelheim, Corbus, GSK, Roche, Merck and personal fees from Boehringer Ingelheim and Ikaria.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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