Validation of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in an academic tertiary

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Irene Schmidtmann1, Daniel Kraus2, Arndt Weinmann2

  • 1Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.

RMD Open
|July 7, 2023
PubMed

Insights

The 2019 EULAR/ACR systemic lupus erythematosus (SLE) criteria are sensitive and specific for outpatients. They showed good agreement with 1997 ACR criteria, confirming their utility in clinical practice.

Area of Science:

  • Rheumatology
  • Immunology
  • Clinical Diagnostics

Background:

  • Systemic lupus erythematosus (SLE) classification requires accurate diagnostic criteria.
  • Previous criteria, such as the 1997 ACR and 2012 SLICC, have been instrumental but may require updates.
  • Evaluating new criteria in diverse patient cohorts is crucial for clinical application.

Purpose of the Study:

  • To evaluate the sensitivity and specificity of the 2019 EULAR/ACR classification criteria for SLE.
  • To compare the performance of the 2019 criteria against the 1997 ACR and 2012 SLICC criteria.
  • To assess the utility of the 2019 criteria in an outpatient academic tertiary care setting.

Main Methods:

  • A prospective and retrospective observational cohort study design was employed.
  • 3377 patients were analyzed, including those with SLE, non-SLE autoimmune-mediated rheumatic diseases (ARD), and non-ARD conditions.
  • Statistical analysis focused on sensitivity, specificity, and Youden Indexes for comparing classification criteria.

Main Results:

  • The 2019 EULAR/ACR criteria demonstrated higher sensitivity (87.0%) than the 1997 ACR criteria (81.8%).
  • Specificity was slightly lower for the 2019 criteria (98.1%) compared to the 1997 criteria (99.5%).
  • Key sensitive indicators included ANA positivity and anti-dsDNA antibodies, while specific indicators included lupus nephritis classes and low complement levels.

Conclusions:

  • The 2019 EULAR/ACR SLE classification criteria were confirmed as sensitive and specific in this independent academic medical center cohort.
  • The 2019 criteria showed very good overall agreement with the 1997 ACR criteria.
  • These findings support the clinical utility of the 2019 criteria for classifying SLE in outpatients.
Abstract

Keywords:
Autoimmune DiseasesLupus Erythematosus, SystemicSystemic Lupus Erythematosus

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