SAN DIEGO—Proposed classification criteria for systemic lupus erythematosus (SLE), which are supported but not yet approved by the ACR and EULAR, debuted on Nov. 7 at the 2017 ACR/ARHP Annual Meeting.
An international steering committee developed and validated the criteria, with patient input and the consensus of more than 150 global SLE experts. Researchers referred to both the 1997 ACR revised criteria and the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria when developing the new criteria, said Martin Aringer, MD, steering committee co-chair and chief of rheumatology at University Medical Center Carl Gustav Carus in Dresden, Germany.1 The committee set ambitious goals: to achieve higher sensitivity and specificity than previous criteria, account for lupus heterogeneity, incorporate manifestations to help identify early lupus patients and achieve worldwide consensus, using an expert-driven, data-driven methodology.2
Classification criteria are designed to identify a homogeneous set of patients for inclusion in clinical trials and translational studies, not to diagnose patients. “Diagnosis is individual,” Dr. Aringer said. “We look for the perfect therapy based on the individual prognosis. For classification, the aim is totally different. In diagnosis, we are entitled to use all the information we can gather on an individual patient. For classification, it has to be a feasible set of objective criteria.”
Although sensitivity is extremely critical for diagnosis to select therapies, it can be annoying in classification, because it is acceptable to exclude one or two patients from a large trial, Dr. Aringer said. “Diagnosis can be questioned again if the disease does not perform the way you expect, but in classification, you typically cannot go back and change the inclusion or exclusion. So specificity is very important.”
In classification, common features are most important, said Dr. Aringer. Although each lupus patient is unique, all have autoantibodies to nuclear antigens (ANAs), as well as many other autoantibodies, and evidence of immune complex deposition from histology to complement to interferon signature. This leads to many different organ manifestations in SLE. “ANA has very high sensitivity, but its specificity is pretty low. For anti-Smith antibodies, it’s the other way around. So it doesn’t make sense to have them side by side in the criteria,” said Dr. Aringer. They hypothesized that ANA would be the entry criterion and then tested if that was feasible.
Many conditions have overlapping features with SLE, “but if two of these attributes are found together, especially in a patient who also has autoantibodies, it’s usually SLE,” he said.
One thing I don’t like in this criteria ….that is it is mandatory to have positive ANA testing to apply the criteria….this would result in many false negative cases on applying this criteria….. because all of us know that some SLE cases have negative ANA and DNA but they have consumed complement C3 and C4 …so according to the SLICC classification criteria they are having SLE but according to the New criteria they aren’t….!!!!
I agree. And about the patients ANA negative, but anti-SSA/Ro positive? And, these new criteria are too sensive. Everything is lupus?
In1995 I was diagnosed with autoimmune hepatitis following years of pain meds and neck surgeries . I was told after blood work I had positive ANA, negative RA, and a gamete of positive inflammation and other test hoeing autoimmune disease. The Rheumatologist walk in to my hospital room and said I had a classic butterfly rash on my face, blistering in mouth and nose, horrible headaches, but still working. So I went on about 6 months of prednisone and taken off any meds that process through my liver. I got better. I was told my trigger was the trigger of my first flare. Nothing but fatigue and headaches, occasional achy joints. So I rarely went to rheumatologist . 2 years ago I had anaphylactic shock from peanuts, my disease raised its ugly head. Now my mom has had lupus since she was twenty five, discoid type. My youngest daughter diagnosed with SLE at age nine, after very strange lumps on her tendons. She also had kidney issues, . So three women in my family lupus. My currrnt flare has been raging for coming up on two years. Horrible, could not turn over in bed by my self from pain let alone walk. I can walk some now but not for long, cannot stand in lines, can’t bath myself, I have horrible chest pain from pleurisy and lupus pneumonitis. I have trouble swallowing. My joints are hurting all the time. I am now on oxygen. I have two brain masses, and several lumps or masses growing on my groin and abdominal area. My lymph nodes are huge and some are painless while others mainly my temporal nodes are painful. Last night I awoke with vomit on me choking on it and coughing for hours. I am on lots of meds but progress is slow. Last blood work Ana negative.. WTF… my Dr says it doesn’t matter it is Lupus. New Rheumatologist lets do more test, lupus always had positive ANA and RA.. ugh no guys I have Lupus and I am sick. I aspirated last night, I could have died in my sleep easily and now need to worry about..go by the symptom list it seems to be very accurate wether you have one initial episode or many. Hang in and find some Dr that listen to your symptoms, write them down. Good luck