Validation of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in ANA-positive Chinese patients

Chung, Yuen Kwan; Ho, Ling Yin; Lee, Carolyn; To, Chi Hung; Mok, Chi Chiu

doi:10.1177/1759720x221100300

Cited by 7 publications

(6 citation statements)

References 37 publications

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“…The fulfillment of the EULAR/ACR, SLICC, and ACR criteria of these patients was obtained, and their performance for a clinical diagnosis of SLE was compared. 2 The current study was conducted to further explore the relationship between the EULAR/ACR score and organ damage in those judged to be clinical SLE in the validation study.…”

Section: Methodsmentioning

confidence: 99%

“…In a recent validation study of Chinese SLE patients using the attribution rule to the non-SLE controls, we showed that the EULAR/ACR criteria had a similar sensitivity (96.1% vs 97.9%) but slightly higher specificity (95.0% vs 92.5%) when than the SLICC criteria. 2 Several recent studies involving adult and pediatric patients have suggested that the EULAR/ACR classification criteria scores might have prognostic value. These studies reported an association between higher EULAR/ ACR SLE score at diagnosis and organ damage (in particular renal) and reduced survival.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Mok

Chung²,

Lee³

et al. 2023

Lupus

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Mok

Chung²,

Lee³

et al. 2023

Lupus

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“…The 2019 EULAR/ACR classification criteria for SLE and the SLE Disease Activity Index (SLEDAI) include several serological parameters along with signs, symptoms, radiological features, and histologic and pathological findings for the classification of SLE [ 127 , 128 ]. However, in the absence of concurrent systemic inflammation, these parameters often cannot be used to predict neuropsychiatric disease activity [ 129 ].…”

Section: Investigationsmentioning

confidence: 99%

Neuropsychiatric Systemic Lupus Erythematosus: Molecules Involved in Its Imunopathogenesis, Clinical Features, and Treatment

Justiz-Vaillant,

Gopaul,

Soodeen

et al. 2024

Molecules

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Systemic lupus erythematosus (SLE) is an idiopathic chronic autoimmune disease that can affect any organ in the body, including the neurological system. Multiple factors, such as environmental (infections), genetic (many HLA alleles including DR2 and DR3, and genes including C4), and immunological influences on self-antigens, such as nuclear antigens, lead to the formation of multiple autoantibodies that cause deleterious damage to bodily tissues and organs. The production of autoantibodies, such as anti-dsDNA, anti-SS(A), anti-SS(B), anti-Smith, and anti-neuronal DNA are characteristic features of this disease. This autoimmune disease results from a failure of the mechanisms responsible for maintaining self-tolerance in T cells, B cells, or both. Immune complexes, circulating antibodies, cytokines, and autoreactive T lymphocytes are responsible for tissue injury in this autoimmune disease. The diagnosis of SLE is a rheumatological challenge despite the availability of clinical criteria. NPSLE was previously referred to as lupus cerebritis or lupus sclerosis. However, these terms are no longer recommended because there is no definitive pathological cause for the neuropsychiatric manifestations of SLE. Currently, the treatment options are primarily based on symptomatic presentations. These include the use of antipsychotics, antidepressants, and anxiolytic medications for the treatment of psychiatric and mood disorders. Antiepileptic drugs to treat seizures, and immunosuppressants (e.g., corticosteroids, azathioprine, and mycophenolate mofetil), are directed against inflammatory responses along with non-pharmacological interventions.

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“…In 2019, the European League Against Rheumatism/American College of Rheumatology endorsed “positive ANA (titer ≥ 1:80 by HEp-2 immunofluorescence)” as an entry criterion for systemic lupus erythematosus (SLE) ( 1 ). This criterion was suitable for SLE classification in patients from south China ( 2 ). Furthermore, patients with SLE exhibit elevated levels of total immunoglobulin G (IgG) and ANA IgG subclasses compared with those with other autoimmune diseases ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Relationship between autoimmune thyroid antibodies and anti-nuclear antibodies in general patients

Ruan,

Heng,

Yang

et al. 2024

Front. Endocrinol.

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BackgroundThere is no doubt that both Hashimoto thyroiditis and Graves’ disease are autoimmune thyroid diseases (AITDs), but the relationship between anti-nuclear antibody (ANA) and AITDs is poorly studied. The association between thyroid autoantibody levels and ANA positivity was evaluated to assess the role of ANA in AITDs.MethodsWe conducted an analysis using data from 1,149,893 patients registered at our hospital and 53,021 patients registered in the National Health and Nutrition Examination Survey databases. We focused on patients with data for thyroid peroxidase antibody (TPOAb)/ANA, TPOAb/immunoglobulin G (IgG), thyroid-stimulating hormone (TSH) receptor antibody (TRAb)/ANA, TRAb/IgG, TSH/ANA, or TSH/IgG.ResultsANA positivity rates were 12.88% and 21.22% in TPOAb/ANA and TSH/ANA patients, respectively. In TPOAb/IgG and TSH/IgG data, high IgG levels (≥15 g/L) were detected in 2.23% and 4.06% of patients, respectively. There were significant differences in ANA positivity rates and high IgG proportions among patients with different TPOAb and TSH levels. TPOAb level was correlated with ANA positivity rate and high IgG proportion, and TSH level was correlated with ANA positivity rate. Regression analysis showed positive correlations between TPOAb levels and ANA positivity risk or high IgG risk, TSH levels and high IgG risk, and elevated TSH and ANA positivity risk. Of patients with TRAb/ANA data, 35.99% were ANA-positive, and 13.93% had TRAb levels ≥1.75IU/L; 18.96% of patients with TRAb/IgG data had high IgG levels, and 16.51% had TRAb levels ≥1.75IU/L. ANA positivity rate and high IgG proportion were not significantly different among different TRAb levels. TRAb levels, ANA positivity risk and high IgG risk were not correlated.ConclusionANA positivity and high IgG are related to Hashimoto thyroiditis but not Graves’ disease, which implies distinct pathophysiological mechanisms underlying the AITDs.

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Validation of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in ANA-positive Chinese patients

Cited by 7 publications

References 37 publications

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

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

Neuropsychiatric Systemic Lupus Erythematosus: Molecules Involved in Its Imunopathogenesis, Clinical Features, and Treatment

Relationship between autoimmune thyroid antibodies and anti-nuclear antibodies in general patients

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