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2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus.
Aringer, Martin; Costenbader, Karen; Daikh, David; Brinks, Ralph; Mosca, Marta; Ramsey-Goldman, Rosalind; Smolen, Josef S; Wofsy, David; Boumpas, Dimitrios T; Kamen, Diane L; Jayne, David; Cervera, Ricard; Costedoat-Chalumeau, Nathalie; Diamond, Betty; Gladman, Dafna D; Hahn, Bevra; Hiepe, Falk; Jacobsen, Søren; Khanna, Dinesh; Lerstrøm, Kirsten; Massarotti, Elena; McCune, Joseph; Ruiz-Irastorza, Guillermo; Sanchez-Guerrero, Jorge; Schneider, Matthias; Urowitz, Murray; Bertsias, George; Hoyer, Bimba F; Leuchten, Nicolai; Tani, Chiara; Tedeschi, Sara K; Touma, Zahi; Schmajuk, Gabriela; Anic, Branimir; Assan, Florence; Chan, Tak Mao; Clarke, Ann Elaine; Crow, Mary K; Czirják, László; Doria, Andrea; Graninger, Winfried; Halda-Kiss, Bernadett; Hasni, Sarfaraz; Izmirly, Peter M; Jung, Michelle; Kumánovics, Gábor; Mariette, Xavier; Padjen, Ivan; Pego-Reigosa, José M; Romero-Diaz, Juanita.
Affiliation
  • Aringer M; Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany martin.aringer@uniklinikum-dresden.de Sindhu.Johnson@uhn.ca.
  • Costenbader K; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Daikh D; University of California at San Francisco and VA Medical Center, San Francisco, California, USA.
  • Brinks R; Policlinic and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
  • Mosca M; Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Ramsey-Goldman R; Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
  • Smolen JS; Department of Rheumatology, Medicine III, Medical University of Vienna, Vienna, Austria.
  • Wofsy D; Department of Medicine, Russell/Engleman Rheumatology Research Center, University of California at San Francisco, San Francisco, California, USA.
  • Boumpas DT; Joint Academic Rheumatology Program, Medical School, National and Kapodestrian University of Athens, and Biomedical Research Foundation of the Athens Academy, Athens, Greece.
  • Kamen DL; Departments of Internal Medicine and Rheumatology, Clinical Immunology and Allergy, Medical School, University of Cyprus, Nicosia, Cyprus.
  • Jayne D; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
  • Cervera R; Department of Medicine, University of Cambridge, Cambridge, UK.
  • Costedoat-Chalumeau N; Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.
  • Diamond B; Medicine, Toronto Western Hospital, University Health Network, Mount Sinai Hospital, University of Toronto, Toronto Scleroderma Research Program, Toronto, Ontario, Canada.
  • Gladman DD; Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
  • Hahn B; Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
  • Hiepe F; Division of Rheumatology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
  • Jacobsen S; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Khanna D; Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  • Lerstrøm K; Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA.
  • Massarotti E; Lupus Europe, Co-Opted Trustee for Research, Essex, UK.
  • McCune J; Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Ruiz-Irastorza G; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
  • Sanchez-Guerrero J; Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA.
  • Schneider M; Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Bizkaia, The Basque Country, Spain.
  • Urowitz M; Division of Rheumatology, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • Bertsias G; Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Hoyer BF; Policlinic and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
  • Leuchten N; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Lupus Clinic, Toronto, Ontario, Canada.
  • Tani C; Rheumatology, Clinical Immunology and Allergy, University of Crete Medical School, Heraklion, Crete, Greece.
  • Tedeschi SK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Touma Z; Department of Medicine III, University of Schleswig-Holstein at Kiel, Kiel, Germany.
  • Schmajuk G; Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany.
  • Anic B; Department of Clinical and Experimental Medicine, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Assan F; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
  • Chan TM; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Clarke AE; Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
  • Crow MK; University of California at San Francisco and VA Medical Center, San Francisco, California, USA.
  • Czirják L; Division of Clinical Immunology and Rheumatology, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Zagreb, Croatia.
  • Doria A; Department of Rheumatology, Université Paris Sud, Hôpitaux Universitaires Paris-Sud, AP-HP, INSERM UMR 1184, Le Kremlin-Bicêtre, France.
  • Graninger W; Department of Medicine, University of Hong Kong, Hong Kong, China.
  • Halda-Kiss B; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
  • Hasni S; Hospital for Special Surgery, Ney York, New York, USA.
  • Izmirly PM; Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary.
  • Jung M; Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy.
  • Kumánovics G; Internal Medicine, Medical University of Graz, Graz, Austria.
  • Mariette X; Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary.
  • Padjen I; Lupus Clinical Research Program, Office of the Clinical Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.
  • Pego-Reigosa JM; Rheumatology, New York University School of Medicine, New York, New York, USA.
  • Romero-Diaz J; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Ann Rheum Dis ; 78(9): 1151-1159, 2019 09.
Article in En | MEDLINE | ID: mdl-31383717
ABSTRACT

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.
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Full text: 1 Database: MEDLINE Main subject: Rheumatology / Societies, Medical / Rheumatic Diseases / Lupus Erythematosus, Systemic Type of study: Prognostic_studies Limits: Humans Language: En Year: 2019 Type: Article
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Full text: 1 Database: MEDLINE Main subject: Rheumatology / Societies, Medical / Rheumatic Diseases / Lupus Erythematosus, Systemic Type of study: Prognostic_studies Limits: Humans Language: En Year: 2019 Type: Article