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The bm12 Inducible Model of Systemic Lupus Erythematosus (SLE) in C57BL/6 Mice
Published on: November 1, 2015
Review of ACR hematologic criteria in systemic lupus erythematosus
A H Kao1, S Manzi, R Ramsey-Goldman
1Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, PA, USA.
Insights
The hematologic criterion for diagnosing systemic lupus erythematosus (SLE) requires careful interpretation to ensure accuracy. Despite potential confounding factors, its core elements remain valuable for SLE diagnosis when other causes are excluded.
Area of Science:
- Rheumatology
- Hematology
- Immunology
Background:
- The diagnosis of systemic lupus erythematosus (SLE) relies on specific criteria, including hematologic findings.
- The 1982 American College of Rheumatology (ACR) criteria incorporate four hematologic elements as a single disorder.
Purpose of the Study:
- To evaluate the diagnostic value, clinical relevance, and prognostic significance of the hematologic criterion in SLE.
- To assess the accuracy and interpretation challenges of hematologic markers in SLE diagnosis.
Main Methods:
- A comprehensive literature review was performed.
- Analysis focused on the sensitivity, specificity, and prevalence of individual hematologic elements in SLE diagnosis.
- Consideration of confounding factors affecting hematologic parameters was included.
Main Results:
- Individual hematologic criteria elements show variable sensitivity (18–46%) but high specificity (89–99%).
- Accurate interpretation is crucial, as non-specific anemia or drug/infection-induced cytopenias can affect diagnostic accuracy.
- The Systemic Lupus International Collaborating Clinics (SLICC) committee recommends maintaining the current hematologic criteria with proper exclusion of other causes.
Conclusions:
- The hematologic criterion is a valuable component of SLE diagnosis when interpreted correctly.
- Excluding other causes of cytopenia is essential for accurate application of the hematologic criterion in SLE.
- Despite limitations, the established hematologic elements are recommended for continued use in SLE diagnosis by SLICC.
Abstract:
We have conducted a thorough literature review to evaluate the relative value of the hematologic criterion in making a diagnosis of systemic lupus erythematosus (SLE), its clinical relevance, and its prognostic significance. In the updated 1982 ACR criteria, the presence of one or more of the four elements: 1) hemolytic anemia (with reticulocytosis); 2) leukopenia (<4000/microL on two or more occasions); 3) lymphopenia (< 1500/microL on two or more occasions); or 4) thrombocytopenia (< 100,000/microL in the absence of offending drugs) is now considered as a single hematologic disorder. The sensitivity and specificity of the individual elements of the hematologic criterion range from 18 to 46% and 89 to 99%, respectively. The accuracy of the hematologic criterion requires proper interpretation. For example, many studies reported the presence of anemia that was not clearly defined and likely included anemia from etiologies other than hemolytic anemia, thereby causing an overestimation of the prevalence. In addition, medications such as corticosteroids and cytotoxic agents, and viral infections, can also contribute to a reduction in lymphocyte count. Despite these limitations, the SLICC committee recommends no change in the elements of the hematologic criterion when this criterion is properly interpreted and other causes of cytopenia are excluded.
