Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus

• Type of Material: Article
• Authors: Michelle Petri, Johns Hopkins University; Ana-Maria Orbai, Johns Hopkins University; Graciela S. Alarcon, University of Alabama Birmingham; Caroline Gordon, University of Birmingham; Joan T. Merrill, Oklahoma Medical Research Foundation; Paul R. Fortin, Laval University; Ian N. Bruce, The University of Manchester; David Isenberg, University College London; Daniel J. Wallace, Cedars-Sinai Medical Center; Ola Nived, University Lund Hospital; Gunnar Sturfelt, University Lund Hospital; Rosalind Ramsey-Goldman, Northwestern University; Sang-Cheol Bae, Hanyang University Hospital for Rheumatic Diseases; John G. Hanly, Dalhousie University; Jorge Sanchez-Guerrero, Mt Sinai Hospital; Ann Clarke, McGill University; Cynthia Aranow, Feinstein Institute for Medical Research Manhasset; Susan Manzi, Allegheny Singer Research Institute; Murray Urowitz, Toronto Western Hospital; Dafna Gladman, Toronto Western Hospital; Kenneth Kalunian, University of California; Melissa Costner, North Dallas Dermatology Associates; Victoria P. Werth, University of Pennsylvania; Asad Zoma, Lanarkshire Centre for Rheumatology; Sasha Bernatsky, McGill University; S Sam Lim, Emory University
• Language: English
• Date: 2012-08-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 by the American College of Rheumatology.
• Final Published Version (URL): http://dx.doi.org/10.1002/art.34473
• Title of Journal or Parent Work: Arthritis and Rheumatism
• ISSN: 0004-3591
• Volume: 64
• Issue: 8
• Start Page: 2677
• End Page: 2686
• Grant/Funding Information: Dr. Ana-Maria Orbai is supported by NIH grant T32 AR048522.; Supported by NIAMS (R01AR043727) and Lupus Foundation of America.; Also supported by an unrestricted Research Grant from Human Genome Sciences.
• Keywords: ANTIBODIES; NEPHRITIS; Life Sciences & Biomedicine; Rheumatology; WEIGHTED CRITERIA; RHEUMATISM-ASSOCIATION CRITERIA; Science & Technology; ARTHRITIS; OF-RHEUMATOLOGY CRITERIA; REVISED CRITERIA
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery

Abstract

Objective The Systemic Lupus International Collaborating Clinics (SLICC) group revised and validated the American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria in order to improve clinical relevance, meet stringent methodology requirements, and incorporate new knowledge regarding the immunology of SLE. Methods The classification criteria were derived from a set of 702 expert-rated patient scenarios. Recursive partitioning was used to derive an initial rule that was simplified and refined based on SLICC physician consensus. The SLICC group validated the classification criteria in a new validation sample of 690 new expert-rated patient scenarios. Results Seventeen criteria were identified. In the derivation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (49 versus 70; P = 0.0082) and had greater sensitivity (94% versus 86%; P < 0.0001) and equal specificity (92% versus 93%; P = 0.39). In the validation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (62 versus 74; P = 0.24) and had greater sensitivity (97% versus 83%; P < 0.0001) but lower specificity (84% versus 96%; P < 0.0001). Conclusion The new SLICC classification criteria performed well in a large set of patient scenarios rated by experts. According to the SLICC rule for the classification of SLE, the patient must satisfy at least 4 criteria, including at least one clinical criterion and one immunologic criterion OR the patient must have biopsy-proven lupus nephritis in the presence of antinuclear antibodies or anti-double-stranded DNA antibodies.