Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus

Wiley - Tập 64 Số 8 - Trang 2677-2686 - 2012
Michelle Petri1, Ana‐Maria Orbai1, Graciela S. Alarcón2, Caroline Gordon3, Joan T. Merrill4, Paul R. Fortin5, Ian N Bruce6, David Isenberg7, Daniel J. Wallace8, Ola Nived9, Gunnar Sturfelt9, Rosalind Ramsey‐Goldman10,11,12, Sang‐Cheol Bae10,11,12, John G. Hanly, Jorge Sánchez‐Guerrero13, Ann E. Clarke14, Cynthia Aranow15, Susan Manzi16, Murray Urowitz17, Dafna D. Gladman18, Kenneth Kalunian18, Melissa Costner19, Victoria P. Werth, Asad Zoma20,21, Sasha Bernatsky22, Guillermo Ruiz‐Irastorza15, Munther A. Khamashta23, Søren Jacobsen24, Jill P. Buyon, Peter J. Maddison25, Mary Anne Dooley, Ronald van Vollenhoven, Ellen M. Ginzler26, Thomas Stoll27, Christine A. Peschken28, Joseph L. Jorizzo, Jeffrey P. Callen, S. Sam Lim, Barri J. Fessler, Murat Ỉnanç, Diane L. Kamen, Anisur Rahman29, Kristján Steinsson10,11,12, Andrew G. Franks, Lisa Sigler10,11,12, Suhail Hameed10,11,12, Hong Fang10,11,12, Ngoc Minh Pham10,11,12, Robin L. Brey10,11,12, Michael H. Weisman, Gerald McGwin30, Laurence S. Magder
1Division of Rheumatology, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 7500, Baltimore, MD, 21205, USA
2Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
3Rheumatology Research Group School of Immunity and Infection College of Medical and Dental Sciences University of Birmingham Birmingham, B15 2TT, UK
4Department of Clinical Pharmacology Oklahoma Medical Research Foundation Oklahoma City, OK 73104, USA
5Centre Hospitalier Universitaire de Québec Université Laval Quebec City Quebec, CANADA G1V-2L9
6Arthritis Research UK Epidemiology Unit, School of Translational Medicine, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK M13 9PT
7Centre for Rheumatology Research Room 424, Rayne Institute 5 University Street London WC1E 6JF, UK
8Cedars-Sinai Medical Center David Geffen School of Medicine University of California Los Angeles, CA 90048, USA
9Department of Rheumatology University Hospital S-22185 Lund, SWEDEN
10Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
11 University of Alabama at Birmingham Faculty Office Tower 844 510 20th Street South Birmingham, AL 35294, USA
12Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD 21205, USA.
13Division of Rheumatology, Departments of Medicine and Pathology Capital Health and Dalhousie University Halifax, Nova Scotia, CANADA B3H 4K4
14Division of Rheumatology Mount Sinai Hospital and University Health Network Toronto, Ontario, CANADA
15Divisions of Allergy/Clinical Immunology, Rheumatology, and Clinical Epidemiology Department of Medicine McGill University Health Centre Montreal, Quebec, CANADA H3G 1A4
16Feinstein Institute for Medical Research, Manhasset, NY 11030, USA
17Department of Medicine, Division of Rheumatology Allegheny Singer Research Institute Allegheny General Hospital Pittsburgh, PA 15212, USA
18Toronto Western Hospital Toronto, Ontario, CANADA M5T 2S8
19Division of Rheumatology, Allergy and Immunology UCSD School of Medicine LaJolla, CA 92037, USA
20Department of Dermatology Philadelphia V.A. Medical Center University of Pennsylvania
21School of Medicine Philadelphia, PA 19104, USA
22Lanarkshire Centre for Rheumatology Hairmyres Hospital East Kilbride G75 8RG, SCOTLAND, UK
23Unidad de Investigacion de Enfermedades Autoinmunes Hospital Universitario Cruces Universidad del Pais Vasco 48903 Barakaldo, SPAIN
24Lupus Research Unit, The Rayne Institute St Thomas Hospital Lambeth Palace Road London SE1 7EH, UK
25Division of Rheumatology, New York University School of Medicine, New York, NY 10016, USA
26Department of Rheumatology Karolinska University Hospital 17176 Stockholm, SWEDEN
27Department of Medicine SUNY Downstate Medical Center Brooklyn, NY 11203, USA
28Chefarzt Rheumatologie und Rehabilitation Kantonsspital Schaffhausen Geissbergstr. 81 8208 Schaffhausen, SWITZERLAND
29Division of Rheumatology and Immunology Medical University of South Carolina 96 Jonathan Lucas Street, Suite 912 Charleston, SC 29425, USA
30Division of Rheumatology Cedars-Sinai Medical Center 8700 Beverly Blvd Los Angeles, CA 90048, USA

Tóm tắt

AbstractObjective

The Systemic Lupus International Collaborating Clinics (SLICC) group revised and validated the American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria in order to improve clinical relevance, meet stringent methodology requirements, and incorporate new knowledge regarding the immunology of SLE.

Methods

The classification criteria were derived from a set of 702 expert‐rated patient scenarios. Recursive partitioning was used to derive an initial rule that was simplified and refined based on SLICC physician consensus. The SLICC group validated the classification criteria in a new validation sample of 690 new expert‐rated patient scenarios.

Results

Seventeen criteria were identified. In the derivation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (49 versus 70; P = 0.0082) and had greater sensitivity (94% versus 86%; P < 0.0001) and equal specificity (92% versus 93%; P = 0.39). In the validation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (62 versus 74; P = 0.24) and had greater sensitivity (97% versus 83%; P < 0.0001) but lower specificity (84% versus 96%; P < 0.0001).

Conclusion

The new SLICC classification criteria performed well in a large set of patient scenarios rated by experts. According to the SLICC rule for the classification of SLE, the patient must satisfy at least 4 criteria, including at least one clinical criterion and one immunologic criterion OR the patient must have biopsy‐proven lupus nephritis in the presence of antinuclear antibodies or anti–double‐stranded DNA antibodies.

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Wiley

Tập 64 Số 8

2677-2686

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