2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus

ObjectiveTo develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR).MethodsThis international initiative had four phases. (1) Evaluation of antinuclear antibody (ANA)...

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Published inAnnals of the rheumatic diseases Vol. 78; no. 9; pp. 1151 - 1159
Main Authors Aringer, Martin, Costenbader, Karen, Daikh, David, Brinks, Ralph, Mosca, Marta, Ramsey-Goldman, Rosalind, Smolen, Josef S, Wofsy, David, Boumpas, Dimitrios T, Kamen, Diane L, Jayne, David, Cervera, Ricard, Costedoat-Chalumeau, Nathalie, Diamond, Betty, Gladman, Dafna D, Hahn, Bevra, Hiepe, Falk, Jacobsen, Søren, Khanna, Dinesh, Lerstrøm, Kirsten, Massarotti, Elena, McCune, Joseph, Ruiz-Irastorza, Guillermo, Sanchez-Guerrero, Jorge, Schneider, Matthias, Urowitz, Murray, Bertsias, George, Hoyer, Bimba F, Leuchten, Nicolai, Tani, Chiara, Tedeschi, Sara K, Touma, Zahi, Schmajuk, Gabriela, Anic, Branimir, Assan, Florence, Chan, Tak Mao, Clarke, Ann Elaine, Crow, Mary K, Czirják, László, Doria, Andrea, Graninger, Winfried, Halda-Kiss, Bernadett, Hasni, Sarfaraz, Izmirly, Peter M, Jung, Michelle, Kumánovics, Gábor, Mariette, Xavier, Padjen, Ivan, Pego-Reigosa, José M, Romero-Diaz, Juanita, Rúa-Figueroa Fernández, Íñigo, Seror, Raphaèle, Stummvoll, Georg H, Tanaka, Yoshiya, Tektonidou, Maria G, Vasconcelos, Carlos, Vital, Edward M, Wallace, Daniel J, Yavuz, Sule, Meroni, Pier Luigi, Fritzler, Marvin J, Naden, Ray, Dörner, Thomas, Johnson, Sindhu R
Format Journal Article
LanguageEnglish
Published United States BMJ Publishing Group Ltd and European League Against Rheumatism 01.09.2019
Elsevier Limited
Subjects
Online AccessGet full text
ISSN0003-4967
1468-2060
1468-2060
DOI10.1136/annrheumdis-2018-214819

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Abstract ObjectiveTo develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR).MethodsThis international initiative had four phases. (1) Evaluation of antinuclear antibody (ANA) as an entry criterion through systematic review and meta-regression of the literature and criteria generation through an international Delphi exercise, an early patient cohort and a patient survey. (2) Criteria reduction by Delphi and nominal group technique exercises. (3) Criteria definition and weighting based on criterion performance and on results of a multi-criteria decision analysis. (4) Refinement of weights and threshold scores in a new derivation cohort of 1001 subjects and validation compared with previous criteria in a new validation cohort of 1270 subjects.ResultsThe 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as obligatory entry criterion; followed by additive weighted criteria grouped in seven clinical (constitutional, haematological, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and three immunological (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10. Patients accumulating ≥10 points are classified. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%, compared with 82.8% sensitivity and 93.4% specificity of the ACR 1997 and 96.7% sensitivity and 83.7% specificity of the Systemic Lupus International Collaborating Clinics 2012 criteria.ConclusionThese new classification criteria were developed using rigorous methodology with multidisciplinary and international input, and have excellent sensitivity and specificity. Use of ANA entry criterion, hierarchically clustered and weighted criteria reflect current thinking about SLE and provide an improved foundation for SLE research.
AbstractList To develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR).OBJECTIVETo develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR).This international initiative had four phases. (1) Evaluation of antinuclear antibody (ANA) as an entry criterion through systematic review and meta-regression of the literature and criteria generation through an international Delphi exercise, an early patient cohort and a patient survey. (2) Criteria reduction by Delphi and nominal group technique exercises. (3) Criteria definition and weighting based on criterion performance and on results of a multi-criteria decision analysis. (4) Refinement of weights and threshold scores in a new derivation cohort of 1001 subjects and validation compared with previous criteria in a new validation cohort of 1270 subjects.METHODSThis international initiative had four phases. (1) Evaluation of antinuclear antibody (ANA) as an entry criterion through systematic review and meta-regression of the literature and criteria generation through an international Delphi exercise, an early patient cohort and a patient survey. (2) Criteria reduction by Delphi and nominal group technique exercises. (3) Criteria definition and weighting based on criterion performance and on results of a multi-criteria decision analysis. (4) Refinement of weights and threshold scores in a new derivation cohort of 1001 subjects and validation compared with previous criteria in a new validation cohort of 1270 subjects.The 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as obligatory entry criterion; followed by additive weighted criteria grouped in seven clinical (constitutional, haematological, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and three immunological (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10. Patients accumulating ≥10 points are classified. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%, compared with 82.8% sensitivity and 93.4% specificity of the ACR 1997 and 96.7% sensitivity and 83.7% specificity of the Systemic Lupus International Collaborating Clinics 2012 criteria.RESULTSThe 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as obligatory entry criterion; followed by additive weighted criteria grouped in seven clinical (constitutional, haematological, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and three immunological (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10. Patients accumulating ≥10 points are classified. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%, compared with 82.8% sensitivity and 93.4% specificity of the ACR 1997 and 96.7% sensitivity and 83.7% specificity of the Systemic Lupus International Collaborating Clinics 2012 criteria.These new classification criteria were developed using rigorous methodology with multidisciplinary and international input, and have excellent sensitivity and specificity. Use of ANA entry criterion, hierarchically clustered and weighted criteria reflect current thinking about SLE and provide an improved foundation for SLE research.CONCLUSIONThese new classification criteria were developed using rigorous methodology with multidisciplinary and international input, and have excellent sensitivity and specificity. Use of ANA entry criterion, hierarchically clustered and weighted criteria reflect current thinking about SLE and provide an improved foundation for SLE research.
ObjectiveTo develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR).MethodsThis international initiative had four phases. (1) Evaluation of antinuclear antibody (ANA) as an entry criterion through systematic review and meta-regression of the literature and criteria generation through an international Delphi exercise, an early patient cohort and a patient survey. (2) Criteria reduction by Delphi and nominal group technique exercises. (3) Criteria definition and weighting based on criterion performance and on results of a multi-criteria decision analysis. (4) Refinement of weights and threshold scores in a new derivation cohort of 1001 subjects and validation compared with previous criteria in a new validation cohort of 1270 subjects.ResultsThe 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as obligatory entry criterion; followed by additive weighted criteria grouped in seven clinical (constitutional, haematological, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and three immunological (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10. Patients accumulating ≥10 points are classified. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%, compared with 82.8% sensitivity and 93.4% specificity of the ACR 1997 and 96.7% sensitivity and 83.7% specificity of the Systemic Lupus International Collaborating Clinics 2012 criteria.ConclusionThese new classification criteria were developed using rigorous methodology with multidisciplinary and international input, and have excellent sensitivity and specificity. Use of ANA entry criterion, hierarchically clustered and weighted criteria reflect current thinking about SLE and provide an improved foundation for SLE research.
To develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). This international initiative had four phases. (1) Evaluation of antinuclear antibody (ANA) as an entry criterion through systematic review and meta-regression of the literature and criteria generation through an international Delphi exercise, an early patient cohort and a patient survey. (2) Criteria reduction by Delphi and nominal group technique exercises. (3) Criteria definition and weighting based on criterion performance and on results of a multi-criteria decision analysis. (4) Refinement of weights and threshold scores in a new derivation cohort of 1001 subjects and validation compared with previous criteria in a new validation cohort of 1270 subjects. The 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as obligatory entry criterion; followed by additive weighted criteria grouped in seven clinical (constitutional, haematological, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and three immunological (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10. Patients accumulating ≥10 points are classified. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%, compared with 82.8% sensitivity and 93.4% specificity of the ACR 1997 and 96.7% sensitivity and 83.7% specificity of the Systemic Lupus International Collaborating Clinics 2012 criteria. These new classification criteria were developed using rigorous methodology with multidisciplinary and international input, and have excellent sensitivity and specificity. Use of ANA entry criterion, hierarchically clustered and weighted criteria reflect current thinking about SLE and provide an improved foundation for SLE research.
Author Jacobsen, Søren
Bertsias, George
Touma, Zahi
Tani, Chiara
Diamond, Betty
Meroni, Pier Luigi
Jayne, David
Sanchez-Guerrero, Jorge
Pego-Reigosa, José M
Boumpas, Dimitrios T
Smolen, Josef S
Tedeschi, Sara K
Schmajuk, Gabriela
Johnson, Sindhu R
Hahn, Bevra
Aringer, Martin
Wofsy, David
Padjen, Ivan
Yavuz, Sule
Gladman, Dafna D
Costenbader, Karen
McCune, Joseph
Halda-Kiss, Bernadett
Wallace, Daniel J
Hoyer, Bimba F
Ruiz-Irastorza, Guillermo
Massarotti, Elena
Schneider, Matthias
Anic, Branimir
Doria, Andrea
Naden, Ray
Kamen, Diane L
Costedoat-Chalumeau, Nathalie
Brinks, Ralph
Lerstrøm, Kirsten
Mosca, Marta
Ramsey-Goldman, Rosalind
Khanna, Dinesh
Rúa-Figueroa Fernández, Íñigo
Hasni, Sarfaraz
Vital, Edward M
Cervera, Ricard
Tanaka, Yoshiya
Daikh, David
Seror, Raphaèle
Kumánovics, Gábor
Stummvoll, Georg H
Dörner, Thomas
Graninger, Winfried
Izmirly, Peter M
Assan, Florence
Czirják, László
Mariette, Xavier
Vasconcelos, Carlos
Jung, Michelle
Hiepe, Falk
Clarke, Ann Elaine
Urowitz, Murray
Chan, Tak Mao
Tektonidou, Maria G
Leuchten, Nicolai
Romero-Diaz, Juanit
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  givenname: Ray
  surname: Naden
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  givenname: Sindhu R
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  email: Sindhu.Johnson@uhn.ca
  organization: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Keywords systemic lupus erythematosus
classification criteria
consensus methods
lupus
multi-criteria decision analysis
validation
Language English
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32122908 - Ann Rheum Dis. 2022 Feb;81(2):e22. doi: 10.1136/annrheumdis-2020-217017.
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Snippet ObjectiveTo develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and...
To develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the...
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SubjectTerms Antibodies
Antinuclear antibodies
Antiphospholipid antibodies
Arthritis
Classification
classification criteria
consensus methods
Criteria
Humans
Immunoglobulins
Immunology
Literature reviews
Lupus
Lupus Erythematosus, Systemic - classification
Medical research
multi-criteria decision analysis
Pathogenesis
Patients
Rheumatic Diseases
Rheumatism
Rheumatology
Societies, Medical
Systemic lupus erythematosus
validation
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Title 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus
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