European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) SLE classification criteria item...

Area of Science:

• Rheumatology
• Immunology
• Clinical Diagnostics

Background:

• The European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 classification criteria for systemic lupus erythematosus (SLE) were developed to balance high specificity and sensitivity.
• Understanding the performance of individual criteria and their contribution to the overall diagnostic accuracy is crucial for accurate SLE diagnosis.

Purpose of the Study:

• To analyze the performance of individual items within the EULAR/ACR 2019 classification criteria for SLE.
• To evaluate the contribution of each criterion to the overall sensitivity and specificity of the classification system.

Main Methods:

• Combined EULAR/ACR derivation and validation cohorts (1197 SLE, 1074 non-SLE patients).
• Calculated sensitivity and specificity for antinuclear antibodies (ANA) and 23 specific criteria items.
• Assessed the impact of omitting the EULAR/ACR criteria attribution rule.

Main Results:

• Positive ANA demonstrated 99.5% sensitivity but only 19.4% specificity.
• Individual criteria items varied in sensitivity (e.g., delirium 0.42%, psychosis 1.84%) but showed high specificity (e.g., anti-dsDNA 75.6%).
• Applying the attribution rule improved specificity, especially for joint involvement.

Conclusions:

• Positioning ANA as a highly sensitive, non-specific entry criterion, alongside the attribution rule, contributes to the overall high specificity (>80%) of the EULAR/ACR criteria set.
• The study validates the performance of the EULAR/ACR 2019 criteria in a large cohort, highlighting the interplay between different criteria components for accurate SLE classification.