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- Published on: 29 July 2021
- Published on: 29 July 2021Anti-nuclear antibodies for SLE classification versus diagnosis: titer-specific likelihood ratios to the rescue. Response to Aringer M et al. Ann Rheum Dis. 2021 Feb 10:annrheumdis-2020-219373
Anti-nuclear antibodies for SLE classification versus diagnosis: titer-specific likelihood ratios to the rescue. Response to Aringer M, Brinks R, Dörner T, et al. European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) SLE classification criteria item performance. Ann Rheum Dis. 2021 Feb 10:annrheumdis-2020-219373.
Antinuclear antibodies (ANA) are important laboratory markers for the diagnosis and classification of systemic lupus erythematosus (SLE). In the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for SLE, ANA with titer ≥1:80 are an entry criterion [1].
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Even though ANA 1:80 are highly sensitive for SLE, they have a low specificity. This has recently been reinforced by Aringer et al. [2] who analyzed the performance of the individual items included in the 2019 EULAR/ACR classification criteria for SLE on a large group of SLE patients (n=1197) and non-SLE disease controls (n=1074), including patients with other connective tissue diseases (two-thirds of the controls). In this study, ANA with titer ≥1:80 were highly sensitive (99.5%), but only 19.4% specific for SLE [2]. As ANA are an entry criterion for the 2019 EULAR/ACR classification criteria, the low specificity of ANA for SLE does not affect the specificity of the 2019 SLE classification criteria. An important item that conferred specificity to the 2019 SLE classification was the attribution rule [2]. The a...Conflict of Interest:
None declared.