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Relationship between the EULAR/ACR classification criteria and organ damage in systemic lupus erythematosus
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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