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Validation of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in ANA-positive Chinese
Yuen Kwan Chung1, Ling Yin Ho1, Carolyn Lee2
1Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, China.
Insights
The 2019 EULAR/ACR classification criteria for systemic lupus erythematosus (SLE) show high performance in Chinese patients. These criteria are as effective as SLICC criteria and more sensitive than ACR criteria for diagnosing SLE in ANA-positive individuals.
Area of Science:
- Rheumatology
- Immunology
- Clinical Diagnostics
Background:
- Systemic lupus erythematosus (SLE) diagnosis relies on classification criteria.
- The 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) criteria were developed to improve SLE classification.
- Validation in diverse populations, such as Chinese patients, is crucial for global applicability.
Purpose of the Study:
- To validate the 2019 EULAR/ACR classification criteria for SLE.
- To assess the performance of EULAR/ACR criteria in antinuclear antibody (ANA)-positive Chinese patients.
- To compare the EULAR/ACR criteria with existing SLICC and ACR criteria in this cohort.
Main Methods:
- Retrospective review of medical records of adult patients attending rheumatology clinics (May-September 2019).
- Inclusion of patients with ANA positivity (titer ≥1:80).
- Evaluation of patients against 2019 EULAR/ACR, 2012 SLICC, and 1997 ACR criteria for SLE classification.
Main Results:
- 1533 patients were studied; 562 were diagnosed with clinical SLE.
- The 2019 EULAR/ACR criteria demonstrated high sensitivity (96.1%) and specificity (85.8%) for SLE diagnosis.
- EULAR/ACR criteria showed comparable performance to SLICC criteria and higher specificity in specific subgroups (males, >50 years, disease duration ≤3 years) or with a raised cut-off score (12 points).
Conclusions:
- The 2019 EULAR/ACR criteria are validated for use in Chinese patients with positive ANA, performing comparably to SLICC criteria.
- Both EULAR/ACR and SLICC criteria offer higher sensitivity but lower specificity than ACR criteria.
- Specificity of all criteria is enhanced by applying attribution rules to controls, with EULAR/ACR specificity further improved in certain subgroups or with adjusted cut-offs.
Background:
The aim of this study was to validate the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for systemic lupus erythematosus (SLE) in antinuclear antibody (ANA)-positive Chinese patients.
Methods:
Medical records of all adult patients who attended the rheumatology out-patient clinics between May and September 2019 were reviewed. Patients with ever ANA positive (titre ⩾1:80) were included and evaluated for the fulfilment of the 2019 EULAR/ACR, 2012 Systemic Lupus International Collaborating Clinics (SLICC) and 1997 ACR criteria for SLE classification. The performance of these criteria in predicting a clinical diagnosis of SLE as judged by an independent panel of rheumatologists was studied and compared in different subgroups.
Results:
A total of 1533 patients (88.2% women; age at first clinic attendance 45.5 ± 15.6 years) were studied and 562 patients were judged to be clinical SLE. The sensitivity and specificity of the EULAR/ACR (⩾10 points), SLICC and ACR criteria for a clinical diagnosis of SLE was 96.1%, 97.9% and 86.1%; and 85.8%, 86.3% and 94.3%, respectively. Applying the attribution rule to the non-SLE controls, the specificity of the three criteria increased to 95.0%, 92.5% and 98.8%, respectively. The specificity of the EULAR/ACR criteria was higher in male patients (97.9%), those aged >50 years (97.0%) and disease duration of ⩽3 years (97.6%). Using a cut-off of 12 points, the specificity of the EULAR/ACR criteria was further increased (96.6%) while a high sensitivity (95.0%) was maintained.
Conclusion:
In Chinese patients with a positive ANA, the EULAR/ACR criteria for clinical SLE perform equally well to the SLICC criteria. Both the EULAR/ACR and SLICC are more sensitive but less specific than the ACR criteria. The specificity of all the three criteria is enhanced by applying the attribution rule to controls. The specificity of the EULAR/ACR criteria is higher in certain patient subgroups or when the cut-off score is raised.
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