Validation of the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for systemic sclerosis in patients from a capillaroscopy clinic

Melchor, Sheila; Joven, Beatriz; Andreu, José Luís; Loza, Estíbaliz; Yébenes, María Jesús García de; Carmona, Loreto; Carreira, Patrícia

doi:10.1016/j.semarthrit.2016.05.007

Cited by 10 publications

(4 citation statements)

References 13 publications

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“…That was a deficiency for the 1980 ACR SSc classification criteria. Consistent with previous studies that examined disease characteristics in patients of other nationalities, our study also showed that the 2013 ACR/EULAR SSc classification criteria had improved sensitivity without affecting specificity in Chinese Han populations [5,6,7–10] (Table 3). Also, the 2013 ACR/EULAR criteria had significantly increased sensitivity relative to the 1980 criteria in most SSC patient subgroups, with the exception of patients with more extensive skin thickening, e.g., diffuse cutaneous SSc.…”

Section: Discussionsupporting

confidence: 91%

“…This maybe was the reason for increased sensitivity in patients with an abnormal NVC pattern. Similarly, one study from a capillaroscopy clinic showed that one of individual variables in 2013 criteria with the best sensitivity was capillaroscopic abnormalities(81.1%)[10]. SSc patients with prominent microvascular diseases maybe could be classified earlier with the 2013 criteria.…”

Section: Discussionmentioning

confidence: 99%

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The 2013 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Systemic Sclerosis Could Classify Systemic Sclerosis Patients at Earlier Stage: Data from a Chinese EUSTAR Center

Hou

Zheng

et al. 2016

PLoS ONE

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ObjectivesTo evaluate the performance of the 2013 ACR/EULAR classification criteria for systemic sclerosis (SSc) in clinical practice in a Chinese patient cohort, and to compare outcomes with the 1980 ACR criteria.MethodsPatients clinically diagnosed with SSc between September 2013 and May 2015 were prospectively recruited from the EUSTAR database of the Peking Union Medical College Hospital. Diagnosis of SSc was based on the evaluation of three experienced rheumatologists. Patients diagnosed with other connective tissue diseases were recruited as disease controls. The 1980 ACR and 2013 ACR/EULAR criteria were applied to the cohort, and patients who fulfilled the criteria were classified as definite SSc patients. Sensitivity and specificity were analyzed for the 2013 and 1980 criteria.ResultsA total of 143 SSc patients and 87 patients with other connective diseases were recruited. 41 (28.7%) and 102 (71.3%) cases were diffuse cutaneous SSc and limited cutaneous SSc, respectively. Although the sensitivity of the 2013 criteria (94.4%) exceeded the 1980 criteria (72.7%) (P<0.001), the 1980 and 2013 criteria sets showed no significant difference in specificity (97.7% and 93.1%, respectively, P = 0.278). The sensitivity of the 2013 criteria was significantly higher than the 1980 criteria in some SSc subgroups (e.g., lcSSc, abnormal pattern of nailfold videocapillaroscopy [NVC] and presence of Raynaud’s phenomenon [RP]) compared to others.ConclusionsRelative to the 1980 ACR criteria, in Chinese SSc patients the new 2013 ACR/EULAR criteria had similar specificity and higher sensitivity, especially for patients with mild skin thickening or prominent microvascular diseases.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

The 2013 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Systemic Sclerosis Could Classify Systemic Sclerosis Patients at Earlier Stage: Data from a Chinese EUSTAR Center

Hou

Zheng

et al. 2016

PLoS ONE

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“…Studies validating the revised criteria have been performed separately for RA (16)(17)(18)(19)(20), SLE (21)(22)(23)(24)(25)(26)(27) and SSc (28)(29)(30). Although most of the studies showed an improved sensitivity using the revised/new criteria, some authors have suggested a lower cut-off point to further improve the sensitivity (16,30).…”

Section: Discussionmentioning

confidence: 99%

Performance of the Revised Classification Criteria for Systemic Autoimmune Rheumatic Diseases and Their Overlap Syndromes

et al. 2022

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Objective We evaluated the performance of the revised classification criteria for assessing different systemic autoimmune rheumatic diseases and their overlap syndromes. Methods A total of 652 patients with or highly suspected of having systemic lupus erythematosus (SLE), systemic sclerosis (SSc), polymyositis (PM)/dermatomyositis (DM) or rheumatoid arthritis (RA)were included in this study. The 1997 revised American College of Rheumatology (ACR) and the 2019 European League Against Rheumatism (EULAR)/ACR criteria for SLE, the 1980 ACR and the 2013 ACR/EULAR criteria for SSc, the criteria by Bohan and Peter and the 2017 EULAR/ACR criteria for PM/DM, and the 1987 revised ACR and 2011 ACR/EULAR criteria for RA were used for disease classification. Results The old and new criteria and a clinical diagnosis were used to respectively classify 103, 106 and 105 SLE patients; 35, 47 and 58 SSc patients; 18, 23 and 33 PM/DM patients; and 297, 389 and 468 RA patients. Sensitivity increased from 82.9% to 92.4% in SLE, from 56.9% to 79.3% in SSc, from 54.5% to 66.7% in PM/DM, and from 62.6% to 80.8% in RA. SLE-SSc was the predominant type of clinical overlap syndrome, while SLE-RA was the most classifiable. Conclusion The revised classification criteria for all the diseases showed an improved sensitivity, and SLE-overlap syndrome was predominant, regardless of the criteria sets.

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“…Generally, in these studies, unselected patients with a suspected diagnosis of SSc were included (e.g., patients with Raynaud's phenomenon from a capillaroscopy clinic). In these setting, the sensitivity of the 2013 criteria was reported to range from 94 to 98% using the clinical judgment as gold standard, and performed better than the 1980 criteria [53][54][55][56]. However, the analysis of a real-life cohort with a particular focus on patients with mild/early disease showed that only 56% of patients not satisfying the 1980 criteria, but with an expert diagnosis of SSc, fulfilled the new 2013 criteria [57].…”

Section: Ssc Classificationmentioning

confidence: 99%

A Narrative Review of Pathogenetic and Histopathologic Aspects, Epidemiology, Classification Systems, and Disease Outcome Measures in Systemic Sclerosis

Lazzaroni

Piantoni

Angeli

et al. 2022

Clinic Rev Allerg Immunol

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Systemic sclerosis (SSc) is a rare systemic autoimmune disease, characterized by the presence of three main actors: vasculopathy, immune activation, and fibrosis. This pathologic process is then translated in a clinical picture with great variability among different patients in terms of type of organ involvement, disease severity and prognosis. This heterogeneity is a main feature of SSc, which, in addition to the presence of early phases of the disease characterized by mild symptoms, can explain the high difficulty in establishing classification criteria, and in defining patients’ subsets and disease outcomes. The definition of disease outcomes is particularly relevant in the setting of clinical trials, where the aim is to provide reliable endpoints, able to measure the magnitude of the efficacy of a certain drug or intervention. For this reason, in the last years, increasing efforts have been done to design measures of disease activity, damage, severity, and response to treatment, often in the context of composite indexes. When considering disease outcomes, the experience of the patient represents a relevant and complementary aspect. The tools able to capture this experience, the patient-reported outcomes, have been increasingly used in the last years in clinical practice and in clinical trials, both as primary and secondary endpoints. This comprehensive narrative review on SSc will therefore cover pathogenetic and histopathologic aspects, epidemiology, classification systems, and disease outcome measures, in order to focus on issues that are relevant for clinical research and design of clinical trials.

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Validation of the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for systemic sclerosis in patients from a capillaroscopy clinic

Cited by 10 publications

References 13 publications

The 2013 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Systemic Sclerosis Could Classify Systemic Sclerosis Patients at Earlier Stage: Data from a Chinese EUSTAR Center

The 2013 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Systemic Sclerosis Could Classify Systemic Sclerosis Patients at Earlier Stage: Data from a Chinese EUSTAR Center

Performance of the Revised Classification Criteria for Systemic Autoimmune Rheumatic Diseases and Their Overlap Syndromes

A Narrative Review of Pathogenetic and Histopathologic Aspects, Epidemiology, Classification Systems, and Disease Outcome Measures in Systemic Sclerosis

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