Can SLE classification rules be effectively applied to diagnose unclear SLE cases?

Abstract

Summary Objective Develop a novel classification criteria to distinguish between unclear SLE and MCTD cases. Methods A total of 205 variables from 111 SLE and 55 MCTD patients were evaluated to uncover unique molecular and clinical markers for each disease. Binomial logistic regressions (BLR) were performed on currently used SLE and MCTD classification criteria sets to obtain six reduced models with power to discriminate between unclear SLE and MCTD patients which were confirmed by Receiving Operating Characteristic (ROC) curve. Decision trees were employed to delineate novel classification rules to discriminate between unclear SLE and MCTD patients. Results SLE and MCTD patients exhibited contrasting molecular markers and clinical manifestations. Furthermore, reduced models highlighted SLE patients exhibit prevalence of skin rashes and renal disease while MCTD cases show dominance of myositis and muscle weakness. Additionally decision trees analyses revealed a novel classification rule tailored to differentiate unclear SLE and MCTD patients (Lu-vs-M) with an overall accuracy of 88%. Conclusions Validation of our novel proposed classification rule (Lu-vs-M) includes novel contrasting characteristics (calcinosis, CPK elevated and anti-IgM reactivity for U1-70K, U1A and U1C) between SLE and MCTD patients and showed a 33% improvement in distinguishing these disorders when compare to currently used classification criteria sets. Pending additional validation, our novel classification rule is a promising method to distinguish between patients with unclear SLE and MCTD diagnosis.

Validation of the new classification criteria for systemic lupus erythematosus on a patient cohort from a national referral center: a retrospective study

“…Although stepwise procedure generated optimal criteria combinations for predicting SLE, the strongest predictor turned out to be the overall classification, regarding both SLICC-12 and ACR-97 classification. This is contradictory to the results of Mesa at al (38), who, also employing regression analysis, reported that reduced models, rather than the whole classification, were better discriminators of SLE patients among unclear cases of MCTD. Al-Daabil et al (39) found that strong predictors of SLE were oral ulcerations, renal impairment, and anti-dsDNA antibodies.…”

Unraveling Complexity: A Case of Possible Overlapping Between Mixed Connective Tissue Disease and Systemic Lupus Erythematosus With Renal Involvement

“…Efforts to refine diagnostic criteria and distinguish between SLE and MCTD are underway, with studies exploring novel molecular markers and classification criteria showing promise for improving diagnostic accuracy [ 9 ]. However, the lack of established guidelines and ongoing research highlights the need for further investigation into diagnostic methodologies and clinical presentations to enhance our understanding and management of these complex autoimmune diseases.…”

Low Expression and Clinical Value of hsa_circ_0049224 and has_circ_0049220 in Systemic Lupus Erythematous Patients

“…CircRNAs are much more stable than linear RNAs in cells, and in some tissues their expression levels are 10 times higher, so circRNAs could be regarded as preferred biomarkers of diseases [ 9 , 15 , 16 ]. Many SLE symptoms are quite similar to those of other illnesses, which makes it vague and difficult to diagnose [ 17 ] Currently, the diagnosis of SLE often requires presence of typical clinical manifestations combined with lab indicators [ 18 ]. In the present study, we found that 2 circRNAs (hsa_circ_0049224 and has_circ_0049220) were differently expressed in the PBMCs of healthy controls vs. inactive SLE and active patients, and patients with and without some clinical characteristics of SLE had significantly different expressions of these 2 circRNAs ( Table 2 ), which means that hsa_circ_0049224 and has_circ_0049220 may participate in the pathogenesis of SLE or even be related with the degree of disease activity.…”