Relationship between the EULAR/ACR classification criteria and organ damage in systemic lupus erythematosus

Abstract

Objectives To study the relationship between the 2019 EULAR/ACR classification criteria and organ damage in patients with systemic lupus erythematosus (SLE). Methods Patients involved in a cross-sectional validation study of the EULAR/ACR criteria and judged by a panel of rheumatologists to be clinical SLE were studied. Those who fulfilled the EULAR/ACR criteria at their last clinic visit were stratified into 2 groups based on a cutoff score of 20. The last SLE International Collaborating Clinic (SLICC) Organ Damage Index (SDI) was compared between these two groups. Relationship among the domains of the EULAR/ACR criteria and SDI in all patients was studied by using Spearman’s rank correlation. Results A total of 562 SLE patients were studied (93.6% women; age 36.5 ± 14.1 years; follow-up duration 11.6 ± 6.6 years). The mean and median EULAR/ACR criteria scores in those who fulfilled the EULAR/ACR criteria ( N = 542) were 24.6 ± 7.3 and 24 (interquartile range 19–30), respectively. A total of 392 patients had EULAR/ACR scores of ≥20 (group 1), and 150 patients had scores of 10–19 (group 2). Group 1 patients had significantly higher prevalence of fever, alopecia, oral ulcers, acute lupus skin lesions, arthritis, serositis, seizure, hemolytic anemia, leukopenia, and renal disease and so were the anti-dsDNA, anti-Sm, antiphospholipid antibodies, and low complement state. Organ damage (SDI score of ≥1) occurred in 232 (42.8%) patients. Patients in group 1 had significantly higher SDI scores in the renal, cardiovascular, dermatological, and gonadal domains than group 2. The renal, neuropsychiatric, and antiphospholipid antibody domain scores of the EULAR/ACR criteria correlated positively with the total SDI. The renal domain of the EULAR/ACR criteria had the strongest correlation with renal damage (Rho 0.30; p < 0.001). Patients who scored 10 points in the renal domain had significantly higher renal damage score than those scored 8 points or 4 points. Gonadal damage score was also significantly more common in the 10-point than in the 8-point group. Conclusion In addition to disease classification, the EULAR/ACR SLE criteria may have value in predicting prognosis.

Correspondence on “relationship between the EULAR/ACR classification criteria and organ damage in systemic lupus erythematosus” by Chi Chiu Mok et al

“…In contrast to the results from Chi Chiu Mok et al, 1 we found that the EULAR/ACR score at diagnosis was predictive for damage accrual in the following 10 years. Our study was powered by a higher number of participants which could explain this discrepancy in results (867 vs 251 participants in the analysis).…”

“…These results were corroborated by multivariable regression analysis, patients with the higher score had a 40% increased risk of developing damage (HR 1.40, p = 0.002), and the risk persisted even when analyzing the subgroup of patients without lupus nephritis (HR 1.46, 0 = 0.006). 4 In contrast to the results from Chi Chiu Mok et al, 1 we found that the EULAR/ACR score at diagnosis was predictive for damage accrual in the following 10 years. Our study was powered by a higher number of participants which could explain this discrepancy in results (867 vs 251 participants in the analysis).…”

“…The findings by Chi Chiu Mok et al 1 and our group 3,4 are also consistent with prior studies, 5–7 further validating the concept that the EULAR/ACR criteria in addition to their classification capacity is also an indicator of ominosity, and could aid physicians to identify patients at risk for worse short and long-term outcomes.…”

“…We have demonstrated that a EULAR/ACR criteria score ≥20 at diagnosis predicts a higher disease activity throughout the first 5 years after diagnosis. 3 More recently we showed, consistent with the findings by Chi Chiu Mok et al, 1 that a score ≥20 at diagnosis is able to predict long-term outcomes, including damage and mortality (3).Our study included 867 patients, patients with a score ≥20 more often accrued damage in the following 10 years (46% vs 40%, score ≥20 vs < 20, respectively, p = 0.02). Furthermore, the mean SDI at year 10 was significantly higher in the group with a score ≥20 (1.28 vs 0.97, score ≥20 vs < 20, respectively, p = 0.03) and when assessing the specific domains, this group also had more renal damage.…”

“…We read with great interest the study by Chi Chiu Mok et al, 1 on the relationship between the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria (EULAR/ACR criteria) score and the development of organ damage in patients with Systemic Lupus Erythematosus. The authors showed that patients with a EULAR/ACR criteria score ≥20 on their last clinic visit had significantly higher Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (SDI) scores 2 compared to patients with a score < 20.…”