RT Journal Article
SR Electronic
T1 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1151
OP 1159
DO 10.1136/annrheumdis-2018-214819
VO 78
IS 9
A1 Martin Aringer
A1 Karen Costenbader
A1 David Daikh
A1 Ralph Brinks
A1 Marta Mosca
A1 Rosalind Ramsey-Goldman
A1 Josef S Smolen
A1 David Wofsy
A1 Dimitrios T Boumpas
A1 Diane L Kamen
A1 David Jayne
A1 Ricard Cervera
A1 Nathalie Costedoat-Chalumeau
A1 Betty Diamond
A1 Dafna D Gladman
A1 Bevra Hahn
A1 Falk Hiepe
A1 Søren Jacobsen
A1 Dinesh Khanna
A1 Kirsten Lerstrøm
A1 Elena Massarotti
A1 Joseph McCune
A1 Guillermo Ruiz-Irastorza
A1 Jorge Sanchez-Guerrero
A1 Matthias Schneider
A1 Murray Urowitz
A1 George Bertsias
A1 Bimba F Hoyer
A1 Nicolai Leuchten
A1 Chiara Tani
A1 Sara K Tedeschi
A1 Zahi Touma
A1 Gabriela Schmajuk
A1 Branimir Anic
A1 Florence Assan
A1 Tak Mao Chan
A1 Ann Elaine Clarke
A1 Mary K Crow
A1 László Czirják
A1 Andrea Doria
A1 Winfried Graninger
A1 Bernadett Halda-Kiss
A1 Sarfaraz Hasni
A1 Peter M Izmirly
A1 Michelle Jung
A1 Gábor Kumánovics
A1 Xavier Mariette
A1 Ivan Padjen
A1 José M Pego-Reigosa
A1 Juanita Romero-Diaz
A1 Íñigo Rúa-Figueroa Fernández
A1 Raphaèle Seror
A1 Georg H Stummvoll
A1 Yoshiya Tanaka
A1 Maria G Tektonidou
A1 Carlos Vasconcelos
A1 Edward M Vital
A1 Daniel J Wallace
A1 Sule Yavuz
A1 Pier Luigi Meroni
A1 Marvin J Fritzler
A1 Ray Naden
A1 Thomas Dörner
A1 Sindhu R Johnson
YR 2019
UL http://ard.bmj.com/content/78/9/1151.abstract
AB Objective To develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR).Methods This international initiative had four phases. (1) Evaluation of antinuclear antibody (ANA) as an entry criterion through systematic review and meta-regression of the literature and criteria generation through an international Delphi exercise, an early patient cohort and a patient survey. (2) Criteria reduction by Delphi and nominal group technique exercises. (3) Criteria definition and weighting based on criterion performance and on results of a multi-criteria decision analysis. (4) Refinement of weights and threshold scores in a new derivation cohort of 1001 subjects and validation compared with previous criteria in a new validation cohort of 1270 subjects.Results The 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as obligatory entry criterion; followed by additive weighted criteria grouped in seven clinical (constitutional, haematological, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and three immunological (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10. Patients accumulating ≥10 points are classified. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%, compared with 82.8% sensitivity and 93.4% specificity of the ACR 1997 and 96.7% sensitivity and 83.7% specificity of the Systemic Lupus International Collaborating Clinics 2012 criteria.Conclusion These new classification criteria were developed using rigorous methodology with multidisciplinary and international input, and have excellent sensitivity and specificity. Use of ANA entry criterion, hierarchically clustered and weighted criteria reflect current thinking about SLE and provide an improved foundation for SLE research.