Diagnostic accuracy of the European League against rheumatism/American College of Rheumatology-2019 versus the Systemic Lupus International Collaborating Clinics-2012 versus the ACR-1997 classification criteria in adult systemic lupus erythematosus: A systematic review and meta-analysis

Lu, Wentian; Tian, Fengmei; Ma, Jinlu; Zhong, Ying; Liu, Zhichun; Xue, Leixi

doi:10.3389/fimmu.2022.1023451

Cited by 7 publications

(7 citation statements)

References 53 publications

(104 reference statements)

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“…Nonetheless, as noted in the materials and methods, all patients were checked for strict compliance with SLICC/2012 classification criteria, as is applied at rheumatology center for SLE diagnosis. Although EULAR/ACR 2019 were not used, their sensibility has been shown to be similar as SLICC/2012 criteria [ 56 , 57 ] but there are differences on specificity, therefore could cause bias in the study. Also, the use of secondary sources of data collection leads to potential biases related to patient registries.…”

Section: Discussionmentioning

confidence: 99%

Polyautoimmunity in systemic lupus erythematosus patients: New insights from a cross-sectional study

Santos-Moreno¹,

Arias-Aponte²,

Rodríguez-Vargas³

et al. 2023

Journal of Translational Autoimmunity

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Section: Discussionmentioning

confidence: 99%

Polyautoimmunity in systemic lupus erythematosus patients: New insights from a cross-sectional study

Santos-Moreno¹,

Arias-Aponte²,

Rodríguez-Vargas³

et al. 2023

Journal of Translational Autoimmunity

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“…18 In contrast, the Chinese systematic review and meta-analysis released by Lu et al revealed almost equal diagnostic accuracy for EULAR/ACR and SLICC in the early stages of aSLE, with higher sensitivity (95% and 96%, respectively) for both of them in comparison to ACR 1997. 19 Moreover, previous adult studies have proposed applying a combination of classification criteria to enhance the sensitivity and allow earlier classification and treatment of more patients with high disease burden, 20 as comparable results with respect to the diagnostic sensitivity, specificity, and accuracy of SLICC and EULAR/ACR classification criteria were found. 21 Regarding the reliability of EULAR/ACR criteria among monogenic lupus, in our study, only 8 patients (6.2% of the cases) had confirmed genetic diagnosis of monogenic lupus, including 3 cases of C1q deficiency, 4 cases of DNASE1L3 deficiency, and 1 case of spondyloenchondrodysplasia (due to homozygous deletion in ACP5), and all of them met both the SLICC and EULAR/ ACR criteria.…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Comparison of systemic lupus international collaborating clinics 2012 classification criteria and European league against rheumatism/American college of rheumatology 2019 classification criteria for early detection of childhood onset systemic lupus erythematosus (multi-center study)

Babgi,

Al Marri,

Al-Mayouf

et al. 2024

Lupus

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Objective To assess the performance of the new EULAR/ACR criteria, particularly for early detection of cSLE, in comparison to the SLICC criteria among the pediatric population in multiple centers in Saudi Arabia. Methods We conducted a retrospective study that enrolled pediatric patients up to the age of 14 years who’ve been diagnosed with SLE and followed in pediatric rheumatology clinics at 9 multi-tertiary hospitals in Saudi Arabia from 2010 to 2021 as a case group and were compared to a similar group of pediatric patients who’ve had defined rheumatological diseases other than SLE with a positive ANA titer (≥1:80) as controls. In total, 245 patients were included and distributed as 129 cases (diagnosed by expert pediatric rheumatologists) versus 116 patients in the control group. All relevant clinical information, including history, physical examination findings, and laboratory tests, was documented at the initial presentations. Then, the two sets of SLE classification criteria were applied to both groups to define who’s going to meet both or either one of them. The exclusion criteria included those who had insufficient data or had overlapping or undifferentiated diseases. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating curve (ROC), and accuracy were calculated for SLICC 2012 and EULAR/ACR 2019 criteria (total scores≥ 10 and ≥ 13). We performed a Chi-squared test to compare sensitivity and specificity of SLICC 2012 and EULAR/ACR 2019. Results For SLICC (cut-off ≥4 criteria), the sensitivity was found to be 96.9% (95% CI 92.6%–99.4%) and the specificity was 94.8% (95% CI 89.6%–98.32%), with PPV and NPV of 95.4% and 96.5%, respectively. The ROC for it was 0.96 (95% CI 0.93–0.99), and this criterion had an accuracy of 95%. Regarding EULAR/ACR (total score ≥ 10), the performance measure showed a sensitivity of 99.2% and a specificity of 86.2%. Similarly, PPV was 88.9%; while NPV was a little higher (99.0%) than SLICC. The ROC for EULAR/ACR (total score ≥ 10) was 0.93 (95% CI 0.89–0.96), and this criterion had an accuracy of 93%. However, there was no statistically significant difference between the sensitivity and specificity of either using SLICC or EULAR/ACR (total score ≥ 10), as reflected by a p-value of 0.86 using the Chi-squared test. Although applying the EULAR/ACR with a total score of ≥ 13 revealed lower sensitivity (93.8%) than both the SLICC and the EULAR/ACR (total score ≥ 10), the specificity for it was found to increase up to 91.4% (85.7–96.2%) compared to the (86.2%) specificity of the EULAR/ACR (total score ≥ 10). Conclusion In this cohort among the Saudi population with childhood-onset SLE, the new EULAR/ACR 2019 criteria efficiently enable early detection of SLE, although a more frequent rate of false positives was observed with them. Escalating the total score from ≥ 10 to ≥ 13 in the cSLE population improved the specificity close to that of SLICC 2012. Further prospective studies in pediatrics need to be done for the validation of a cut- off score of ≥ 13 in cSLE rather than the traditional score of ≥ 10 in aSLE.

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“…Finally, the most recent European League Against Rheumatism (EULAR) / ACR 2019 Classification Criteria differs by the obligatory presence of an ANA at titer of at least 1:80, as well as the presence of a minimum number of weighted laboratory and clinical criteria for the classification of SLE ( 7 ). This criteria has demonstrated a higher and similar sensitivity than the 1997 ACR Criteria and 2012 SLICC Criteria, respectively, and comparable specificity ( 8 ).…”

Section: Shortcomings Of the Current Diagnostic Algorithmmentioning

confidence: 96%

The conundrum of neuropsychiatric systemic lupus erythematosus: Current and novel approaches to diagnosis

et al. 2023

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Recognising neuropsychiatric involvement by systemic lupus erythematosus (SLE) is of growing importance, however many barriers to this exist at multiple levels of our currently available diagnostic algorithms that may ultimately delay its diagnosis and subsequent treatment. The heterogeneous and non-specific clinical syndromes, serological and cerebrospinal fluid (CSF) markers and neuroimaging findings that often do not mirror disease activity, highlight important research gaps in the diagnosis of neuropsychiatric SLE (NPSLE). Formal neuropsychological assessments or the more accessible screening metrics may also help improve objective recognition of cognitive or mood disorders. Novel serum and CSF markers, including autoantibodies, cytokines and chemokines have also shown increasing utility as part of diagnosis and monitoring, as well as in distinguishing NPSLE from SLE patients without SLE-related neuropsychiatric manifestations. Novel neuroimaging studies also expand upon our existing strategy by quantifying parameters that indicate microarchitectural integrity or provide an assessment of neuronal function. Some of these novel markers have shown associations with specific neuropsychiatric syndromes, suggesting that future research move away from considering NPSLE as a single entity but rather into its individually recognized neuropsychiatric manifestations. Nevertheless, it is likely that a composite panel of these investigations will be needed to better address the gaps impeding recognition of neuropsychiatric involvement by SLE.

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Diagnostic accuracy of the European League against rheumatism/American College of Rheumatology-2019 versus the Systemic Lupus International Collaborating Clinics-2012 versus the ACR-1997 classification criteria in adult systemic lupus erythematosus: A systematic review and meta-analysis

Cited by 7 publications

References 53 publications

Polyautoimmunity in systemic lupus erythematosus patients: New insights from a cross-sectional study

Polyautoimmunity in systemic lupus erythematosus patients: New insights from a cross-sectional study

Comparison of systemic lupus international collaborating clinics 2012 classification criteria and European league against rheumatism/American college of rheumatology 2019 classification criteria for early detection of childhood onset systemic lupus erythematosus (multi-center study)

The conundrum of neuropsychiatric systemic lupus erythematosus: Current and novel approaches to diagnosis

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