Use of SLICC criteria in a large, diverse lupus registry enables SLE classification of a subset of ACR-designated subjects with incomplete lupus

Abstract

ObjectiveSLE is traditionally classified using the American College of Rheumatology (ACR) criteria. The Systemic Lupus International Collaborating Clinics (SLICC) recently validated an alternative system. This study examined large cohorts of subjects with SLE and incomplete lupus erythematosus (ILE) to compare the impact of ACR and SLICC criteria.MethodsMedical records of subjects in the Lupus Family Registry and Repository were reviewed for documentation of 1997 ACR classification criteria, SLICC classification criteria and medication usage. Autoantibodies were assessed by indirect immunofluorescence (ANA, antidouble-stranded DNA), precipitin (Sm) and ELISA (anticardiolipin). Other relevant autoantibodies were detected by precipitin and with a bead-based multiplex assay.ResultsOf 3575 subjects classified with SLE under at least one system, 3312 (92.6%) were classified as SLE by both systems (SLEboth), 85 only by ACR criteria (SLEACR-only) and 178 only by SLICC criteria (SLESLICC-only). Of 440 subjects meeting 3 ACR criteria, 33.9% (149/440) were SLESLICC-only, while 66.1% (n=291, designated ILE) did not meet the SLICC classification criteria. Under the SLICC system, the complement criterion and the individual autoantibody criteria enabled SLE classification of SLESLICC-only subjects, while SLEACR-only subjects failed to meet SLICC classification due to the combined acute/subacute cutaneous criterion. The SLICC criteria classified more African-American subjects by the leucopenia/lymphopenia criterion than did ACR criteria. Compared with SLEACR-only subjects, SLESLICC-only subjects exhibited similar numbers of affected organ systems, rates of major organ system involvement (∼30%: pulmonary, cardiovascular, renal, neurological) and medication history.ConclusionsThe SLICC criteria classify more subjects with SLE than ACR criteria; however, individuals with incomplete lupus still exist under SLICC criteria. Subjects who gain SLE classification through SLICC criteria exhibit heterogeneous disease, including potential major organ involvement. These results provide supportive evidence that SLICC criteria may be more inclusive of SLE subjects for clinical studies.

Complement Activation in Patients With Probable Systemic Lupus Erythematosus and Ability to Predict Progression to American College of Rheumatology–Classified Systemic Lupus Erythematosus

“…This also highlights an important difference between classification criteria and diagnosis. A similar percentage of SLICC criteria fulfillment was found in a recently described cohort of patients who fulfilled 3 ACR criteria . Furthermore, in the present study, 29% of the 69 patients with a follow‐up visit within 18 months acquired a fourth ACR criterion.…”

Clinical and Serologic Features in Patients With Incomplete Lupus Classification Versus Systemic Lupus Erythematosus Patients and Controls

“…Indeed, approximately one‐third of the ILE patients in this study (149/440) reached SLE classification by the SLICC criteria. However, even patients with incomplete lupus classification by both the SLICC and the ACR criteria may exhibit severe clinical manifestations and require aggressive treatment . Further, some ILE patients at low risk of disease transition or major organ involvement may be overtreated, with increased risk of toxicity compared to the potential benefit.…”

Co-existence of SLE and HIV: A Life Threatening Combination

“…Skin involvement is very common in SLE which includes appearance of malar/discoid rash along with photosensitivity as seen in this patient. According to the SLICC criteria 2012, a person is said to have SLE if he/she meets at least 4 of the 17 with at least one clinical and one immunological criteria [3,4]. We could not carry out coomb's test and complement levels due to lack of availability.…”