Title |
Application of the 2012 Systemic Lupus International Collaborating Clinics classification criteria to patients in a regional Swedish systemic lupus erythematosus register
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Published in |
Arthritis Research & Therapy, January 2015
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DOI | 10.1186/s13075-015-0521-9 |
Pubmed ID | |
Authors |
Anna Ighe, Örjan Dahlström, Thomas Skogh, Christopher Sjöwall |
Abstract |
IntroductionIn 2012, the Systemic Lupus International Collaborating Clinics (SLICC) network presented a new set of criteria (SLICC-12) to classify systemic lupus erythematosus (SLE). The present study is the first to evaluate the performance of SLICC-12 on an adult European study population. Thus, SLICC-12 was applied on confirmed SLE cases in our regional SLE register as well as on individuals with a fair suspicion of systemic autoimmune disease who were referred to rheumatology specialist at our unit.MethodsWe included 243 confirmed SLE cases meeting the 1982 American College of Rheumatology (ACR-82) classification criteria and/or the Fries ¿diagnostic principle¿ (presence of antinuclear antibodies (ANA) on at least one occasion plus involvement of at least two defined organ systems) and 55 controls with possible systemic autoimmune disease, including the presence of any SLE-related autoantibody.ResultsSLICC-12 showed a diagnostic sensitivity of 94% (95% confidence interval (CI) 0.90 to 0.96) compared with 90% (95% CI 0.85 to 0.93) for the updated set of ACR criteria from 1997 (ACR-97), whereas ACR-82 failed to identify every fifth true SLE case. However, the disease specificity of SLICC-12 reached only 74% (95% CI 0.60 to 0.84) and did not change much when requiring involvement of at least two different organs as an indicator of systemic disease. In addition, SLICC-12 misclassified more of the controls than ACR-82, ACR-97 and Fries.ConclusionsEstablishing a standard definition of SLE continues to challenge lupus researchers and clinicians. We confirm that SLICC-12 has advantages with regard to diagnostic sensitivity, whereas we found the diagnostic specificity to be surprisingly low. To accomplish increased sensitivity and specificity figures, a combination of criteria sets for clinical SLE studies should be considered. |
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