Abstract
Background: Different classification criteria for systemic lupus erythematosus (SLE) have been launched over the years. Our aim was to evaluate the performance of the EULAR/ACR-2019, SLICC-2012 and ACR-1997 classification criteria in a cohort of SLE patients with longstanding disease. Methods: Descriptive observational study in 79 patients with established and longstanding SLE. The three classification criteria sets were applied to those patients. Results: Of the 79 patients, 70 were women (88.6%), with a mean age of 51.8 ± 14 years and a mean disease duration of 15.2 ± 11.5 years. The sensitivity of the different criteria were: 51.9%, 87.3% and 86.1% for ACR-1997, SLICC-2012 and EULAR/ACR-2019, respectively. In total, 68 out of 79 patients (53.7%) met all three classification criteria; 11.4% did not meet any classification criteria and were characterized by low SLEDAI (0.6 ± 0.9), low SLICC/ACR Damage Index (0.88 ± 0.56) and fulfilling only skin domains, antiphospholipid antibodies or hypocomplementemia. To fulfill EULAR/ACR-2019 criteria was associated with low complement levels (p < 0.04), high anti-dsDNA levels (p < 0.001), presence of lupus nephritis III-IV (p < 0.05) and arthritis (p < 0.001). Conclusion: The EULAR/ACR-2019 classification criteria showed high sensitivity, similar to SLICC-2012, in SLE patients with longstanding disease. Patients with serological, articular or renal involvement are more likely to fulfill SLICC-2012 or EULAR/ACR-2019 criteria.
Highlights
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with a wide range of clinical manifestations occasionally leading to life-threatening organic failure [1].The diagnosis of systemic lupus erythematosus (SLE) may be challenging as several other conditions can mimic SLE and there are no specific findings to set up the diagnosis [2,3]
No patients met the EULAR/American College of Rheumatology (ACR)-2019 and ACR-1997 but not the SLICC-2012, nor did we find any patients who met only the ACR-1997 criteria
We found significant differences among the three sets of SLE classification criteria and the patients’ characteristics according to the achieved criteria
Summary
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with a wide range of clinical manifestations occasionally leading to life-threatening organic failure [1].The diagnosis of SLE may be challenging as several other conditions can mimic SLE and there are no specific findings to set up the diagnosis [2,3]. Classification criteria do not mean diagnostic criteria, but they are used frequently to detect patients with clinical symptoms and laboratory features of the disease [6]. They can provide diagnostic aids, the classification criteria are characterized by high specificity and usually lower sensitivity; patients with very recent onset of the disease or with less common manifestations may be missed [7]. Longstanding SLE cohorts should mostly meet these criteria, given the fact that they are patients with established disease and the risk of them presenting other systemic autoimmune diseases is slightly lower
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