Relationship between the EULAR/ACR classification criteria and organ damage in systemic lupus erythematosus
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Published on: June 8, 2022
Chi Chiu Mok1, Yuen Kwan Chung2, Carolyn Lee2
1Departments of Medicine, 36658Tuen Mun Hospital, Hong Kong, China.
Insights
The 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) criteria for systemic lupus erythematosus (SLE) correlate with organ damage. Higher scores on the EULAR/ACR criteria indicate a greater likelihood of organ damage in SLE patients.
Area of Science:
- Rheumatology
- Immunology
- Clinical Medicine
Background:
- Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by multi-organ involvement.
- Accurate classification criteria are essential for diagnosis and management of SLE.
- The 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) criteria were developed for SLE classification.
Purpose of the Study:
- To investigate the association between the 2019 EULAR/ACR classification criteria and the presence and extent of organ damage in patients with SLE.
- To evaluate the predictive value of the EULAR/ACR criteria domains for specific organ damage in SLE.
Main Methods:
- A cross-sectional validation study was conducted on 562 patients diagnosed with clinical SLE.
- Patients fulfilling the EULAR/ACR criteria were stratified into two groups based on a cutoff score of 20.
- The SLE International Collaborating Clinics (SLICC) Organ Damage Index (SDI) was compared between groups, and Spearman's rank correlation was used to assess relationships between EULAR/ACR domains and SDI.
Main Results:
- Patients with EULAR/ACR scores ≥20 exhibited a higher prevalence of clinical manifestations and immunological markers associated with SLE.
- A significant correlation was observed between higher EULAR/ACR scores and increased organ damage, particularly in renal, cardiovascular, dermatological, and gonadal domains.
- The renal domain of the EULAR/ACR criteria demonstrated the strongest correlation with renal damage, and specific point thresholds within this domain were linked to significantly higher renal damage scores.
Conclusions:
- The 2019 EULAR/ACR SLE classification criteria not only aid in disease classification but also show potential in predicting prognosis and organ damage.
- These criteria may serve as a valuable tool for identifying SLE patients at higher risk of developing significant organ damage, guiding clinical management and therapeutic strategies.
Objectives:
To study the relationship between the 2019 EULAR/ACR classification criteria and organ damage in patients with systemic lupus erythematosus (SLE).
Methods:
Patients involved in a cross-sectional validation study of the EULAR/ACR criteria and judged by a panel of rheumatologists to be clinical SLE were studied. Those who fulfilled the EULAR/ACR criteria at their last clinic visit were stratified into 2 groups based on a cutoff score of 20. The last SLE International Collaborating Clinic (SLICC) Organ Damage Index (SDI) was compared between these two groups. Relationship among the domains of the EULAR/ACR criteria and SDI in all patients was studied by using Spearman's rank correlation.
Results:
A total of 562 SLE patients were studied (93.6% women; age 36.5 ± 14.1 years; follow-up duration 11.6 ± 6.6 years). The mean and median EULAR/ACR criteria scores in those who fulfilled the EULAR/ACR criteria (N = 542) were 24.6 ± 7.3 and 24 (interquartile range 19-30), respectively. A total of 392 patients had EULAR/ACR scores of ≥20 (group 1), and 150 patients had scores of 10-19 (group 2). Group 1 patients had significantly higher prevalence of fever, alopecia, oral ulcers, acute lupus skin lesions, arthritis, serositis, seizure, hemolytic anemia, leukopenia, and renal disease and so were the anti-dsDNA, anti-Sm, antiphospholipid antibodies, and low complement state. Organ damage (SDI score of ≥1) occurred in 232 (42.8%) patients. Patients in group 1 had significantly higher SDI scores in the renal, cardiovascular, dermatological, and gonadal domains than group 2. The renal, neuropsychiatric, and antiphospholipid antibody domain scores of the EULAR/ACR criteria correlated positively with the total SDI. The renal domain of the EULAR/ACR criteria had the strongest correlation with renal damage (Rho 0.30; p < 0.001). Patients who scored 10 points in the renal domain had significantly higher renal damage score than those scored 8 points or 4 points. Gonadal damage score was also significantly more common in the 10-point than in the 8-point group.
Conclusion:
In addition to disease classification, the EULAR/ACR SLE criteria may have value in predicting prognosis.
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