Systemic lupus erythematosus (SLE): the American College of Rheumatology (ACR) classification criteria are increasingly being replaced by the classification presented below. This was modified in 2012 by the Systemic Lupus International Collaborating Clinics (SLICC) group based on the American College of Rheumatology (ACR) classification criteria . A prerequisite for establishing a diagnosis of SLE is that 4 criteria (at least 1 of which is clinical and 1 immunologic) are met or, in the case of positive ANA or anti-dsDNA antibodies, a histologic diagnosis of lupus nephritis (inflammation of the kidneys) is made. The SLICC criteria are not diagnostic criteria. Note: The SLICC criteria became less well known, although they had better sensitivity (92-97% vs. 77-90%) with poorer specificity (74-88 vs. 91-96%) compared to the 1982 classification criteria. Meanwhile, new classification criteria for lupus patients were presented at the annual international congress of the European League Against Rheumatism (EULAR) (see below). SLE Classification Criteria: Systemic Lupus International Collaborating Clinics (SLICC) Classification Criteria.
Clinical criteria |
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Immunological criteria |
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New EULAR/ACR classification criteria for lupus patients (presented at the annual international congress of the European League Against Rheumatism (EULAR)).
In an initial comparison of 1,000 SLE patients, the new EULAR/ACR criteria are reported to perform much better than the old ACR (85% and 95%), with sensitivity and specificity of 98% and 97%, respectively.
Clinical domains and criteria | Weighting | |
constitutional symptoms | fever | 2 |
Skin | Non-scarring alopeciaoral ulcerasubacute cutaneous or discoid LEacute cutaneous LD. | 2246 |
Arthritis | Synovitis ≥ 2 joints or tenderness in ≥ 2 joints with morning stiffness ≥ 30 minutes | 6 |
Neurology | DeliriumPsychosisSeizures | 236 |
Serositis | Pleural or pericardial effusionacute pericarditis | 56 |
Hematology | LeukopeniaThrombopeniaAutoimmune hemolysis | 344 |
Kidneys | Proteinuria > 0.5 g/24 hLupus nephritis (histol.) type II, VLupus nephritis (histol.) type III, IV | 4810 |
Immunological domains and criteria | Weighting | |
Antiphospholipid-Ak | aCL > 40 GPL or aβ2GPI > 40 GPL or LA +. | 2 |
Complement | C3 or C4 diminishedC3 and C4 diminished | 34 |
high specific auto ac | Anti-dsDNS-AkAnti-Sm-Ak | 66 |
Lupus nephritis classification
Class | Description |
1 | Minimum mesangial LGN |
2 | Mesangioproliferative LGN |
3 | Focal LGN (<50% of glomeruli) active/sclerosed, segmental or global |
4 | Diffuse LGN (>50% of glomeruli) active/sclerosed, segmental or global |
5 | Membraneous LGN |
6 | Sclerosed LGN (>90% of glomeruli). |
Legend: LGN: lupus glomerulonephritis.