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

TitleEuropean League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) SLE classification criteria item performance
Authors
Keywordsantibodies
antiphospholipid
autoantibodies
lupus erythematosus
synovitis
Issue Date2021
PublisherBMJ Publishing Group. The Journal's web site is located at http://ard.bmjjournals.com/
Citation
Annals of the Rheumatic Diseases, 2021, v. 80 n. 6, p. 775-781 How to Cite?
AbstractBackground/objectives: The European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 classification criteria for systemic lupus erythematosus system showed high specificity, while attaining also high sensitivity. We hereby analysed the performance of the individual criteria items and their contribution to the overall performance of the criteria. Methods: We combined the EULAR/ACR derivation and validation cohorts for a total of 1197 systemic lupus erythematosus (SLE) and n=1074 non-SLE patients with a variety of conditions mimicking SLE, such as other autoimmune diseases, and calculated the sensitivity and specificity for antinuclear antibodies (ANA) and the 23 specific criteria items. We also tested performance omitting the EULAR/ACR criteria attribution rule, which defines that items are only counted if not more likely explained by a cause other than SLE. Results: Positive ANA, the new entry criterion, was 99.5% sensitive, but only 19.4% specific, against a non-SLE population that included other inflammatory rheumatic, infectious, malignant and metabolic diseases. The specific criteria items were highly variable in sensitivity (from 0.42% for delirium and 1.84% for psychosis to 75.6% for antibodies to double-stranded DNA), but their specificity was uniformly high, with low C3 or C4 (83.0%) and leucopenia <4.000/mm³ (83.8%) at the lowest end. Unexplained fever was 95.3% specific in this cohort. Applying the attribution rule improved specificity, particularly for joint involvement. Conclusions: Changing the position of the highly sensitive, non-specific ANA to an entry criterion and the attribution rule resulted in a specificity of >80% for all items, explaining the higher overall specificity of the criteria set.
Persistent Identifierhttp://hdl.handle.net/10722/301272
ISSN
2020 Impact Factor: 19.103
2015 SCImago Journal Rankings: 4.537

 

DC FieldValueLanguage
dc.contributor.authorAringer, M-
dc.contributor.authorBrinks, R-
dc.contributor.authorDorner, T-
dc.contributor.authorDaikh, D-
dc.contributor.authorMosca, M-
dc.contributor.authorRamsey-Goldman, R-
dc.contributor.authorSmolen, JS-
dc.contributor.authorWofsy, D-
dc.contributor.authorBoumpas, DT-
dc.contributor.authorKamen, DL-
dc.contributor.authorJayne, D-
dc.contributor.authorCervera, R-
dc.contributor.authorCostedoat-Chalumeau, N-
dc.contributor.authorDiamon, B-
dc.contributor.authorGladman, DD-
dc.contributor.authorHahn, B-
dc.contributor.authorHiepe, F-
dc.contributor.authorJacobsen, S-
dc.contributor.authorKhanna, D-
dc.contributor.authorLerstrom, K-
dc.contributor.authorMassarotti, E-
dc.contributor.authorMaCune, J-
dc.contributor.authorRuiz-Irastorza, G-
dc.contributor.authorSanchez-Guerrero, J-
dc.contributor.authorSchneider, M-
dc.contributor.authorUrowitz, M-
dc.contributor.authorBertsias, G-
dc.contributor.authorHoyer, BF-
dc.contributor.authorLeuchten, N-
dc.contributor.authorSchmajuk, G-
dc.contributor.authorTani, C-
dc.contributor.authorTedeschi, SK-
dc.contributor.authorTouma, Z-
dc.contributor.authorAnic, B-
dc.contributor.authorAssan, F-
dc.contributor.authorChan, TM-
dc.contributor.authorClarke, AE-
dc.contributor.authorCrow, MK-
dc.contributor.authorCzirjak, L-
dc.contributor.authorDoria, A-
dc.contributor.authorGraninger, W-
dc.contributor.authorHalda-Kiss, B-
dc.contributor.authorHasni, S-
dc.contributor.authorIzmirly, PM-
dc.contributor.authorJung, M-
dc.contributor.authorKumanovics, G-
dc.contributor.authorMariette, X-
dc.contributor.authorPadjen, I-
dc.contributor.authorPego-Reigosa, JM-
dc.contributor.authorRomero-Diaz, J-
dc.contributor.authorRua-Figueroa, I-
dc.contributor.authorSeror, R-
dc.contributor.authorStummvoll, GH-
dc.contributor.authorTanaka, Y-
dc.contributor.authorTektonidou, MG-
dc.contributor.authorVasconcelos, C-
dc.contributor.authorVital, EM-
dc.contributor.authorWallace, DJ-
dc.contributor.authorYavuz, S-
dc.contributor.authorMeroni, PL-
dc.contributor.authorFritzier, MJ-
dc.contributor.authorNaden, R-
dc.contributor.authorCostenbader, K-
dc.contributor.authorJohnson, SR-
dc.date.accessioned2021-07-27T08:08:41Z-
dc.date.available2021-07-27T08:08:41Z-
dc.date.issued2021-
dc.identifier.citationAnnals of the Rheumatic Diseases, 2021, v. 80 n. 6, p. 775-781-
dc.identifier.issn0003-4967-
dc.identifier.urihttp://hdl.handle.net/10722/301272-
dc.description.abstractBackground/objectives: The European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 classification criteria for systemic lupus erythematosus system showed high specificity, while attaining also high sensitivity. We hereby analysed the performance of the individual criteria items and their contribution to the overall performance of the criteria. Methods: We combined the EULAR/ACR derivation and validation cohorts for a total of 1197 systemic lupus erythematosus (SLE) and n=1074 non-SLE patients with a variety of conditions mimicking SLE, such as other autoimmune diseases, and calculated the sensitivity and specificity for antinuclear antibodies (ANA) and the 23 specific criteria items. We also tested performance omitting the EULAR/ACR criteria attribution rule, which defines that items are only counted if not more likely explained by a cause other than SLE. Results: Positive ANA, the new entry criterion, was 99.5% sensitive, but only 19.4% specific, against a non-SLE population that included other inflammatory rheumatic, infectious, malignant and metabolic diseases. The specific criteria items were highly variable in sensitivity (from 0.42% for delirium and 1.84% for psychosis to 75.6% for antibodies to double-stranded DNA), but their specificity was uniformly high, with low C3 or C4 (83.0%) and leucopenia <4.000/mm³ (83.8%) at the lowest end. Unexplained fever was 95.3% specific in this cohort. Applying the attribution rule improved specificity, particularly for joint involvement. Conclusions: Changing the position of the highly sensitive, non-specific ANA to an entry criterion and the attribution rule resulted in a specificity of >80% for all items, explaining the higher overall specificity of the criteria set.-
dc.languageeng-
dc.publisherBMJ Publishing Group. The Journal's web site is located at http://ard.bmjjournals.com/-
dc.relation.ispartofAnnals of the Rheumatic Diseases-
dc.rightsAnnals of the Rheumatic Diseases. Copyright © BMJ Publishing Group.-
dc.rightsAuthor’s Accepted Manuscript This article has been accepted for publication in [Journal, Year] following peer review, and the Version of Record can be accessed online at [insert full DOI eg. http://dx.doi.org/10.1136/xxxxx © Authors (or their employer(s)) OR © BMJ Publishing Group Ltd ( for assignments of BMJ Case Reports) <year>-
dc.subjectantibodies-
dc.subjectantiphospholipid-
dc.subjectautoantibodies-
dc.subjectlupus erythematosus-
dc.subjectsynovitis-
dc.titleEuropean League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) SLE classification criteria item performance-
dc.typeArticle-
dc.identifier.emailChan, TM: dtmchan@hku.hk-
dc.identifier.authorityChan, TM=rp00394-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1136/annrheumdis-2020-219373-
dc.identifier.pmid33568386-
dc.identifier.scopuseid_2-s2.0-85100810177-
dc.identifier.hkuros323560-
dc.identifier.volume80-
dc.identifier.issue6-
dc.identifier.spage775-
dc.identifier.epage781-
dc.publisher.placeUnited Kingdom-

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