Systemic Lupus: Classification Systems in the Daily Work of Hospitals

New classification and diagnostic criteria for systemic lupus erythematosus have been proposed in recent years. A new study tests four of these systems for specificity, sensitivity and accuracy.

Various criteria for lupus erythematosus

• The study compares diagnostic criteria according to ACR 1997, SLICC 2012, EULAR/ACR 2019 and Systemic Lupus Erythematosus Risk Probability Index (SLERPI 2020) in clinical practice.
• SLICC 2012 and SLERPI 2020 criteria achieved the highest sensitivity, with ACR 1997 criteria having the highest specificity. 
• The SLICC 2012 classification criteria were the most accurate overall.
• Despite the slightly varying specificity, sensitivity and accuracy, all four systems investigated are suitable for clinical use.

This study from Australia examined four common sets of criteria used to diagnose SLE in clinical practice:

• American College of Rheumatology (ACR) 1997
• Systemic Lupus International Collaborating Clinics (SLICC) 2012
• European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) 2019 and
• Systemic Lupus Erythematosus Risk Probability Index (SLERPI) 2020.

Extensive data base

The study included 394 patients with systemic lupus erythematosus from the Australian Lupus Registry and 123 control cases with another rheumatological disease. Clinical and immunological parameters of all participants were measured and assessed according to the criteria of the four catalogues investigated.

Not all criteria are equally sensitive and specific in diagnosing the disease

The researchers found slight differences in specificity and sensitivity for the detection of SLE:

• The SLICC 2012 and SLERPI 2020 criteria were the most sensitive.
• The best specificity was achieved by the ACR 1997 criteria.
• The SLICC 2012 classification system was the most accurate, even in detecting the early stages of the disease.

What does this mean in practice?

In the present study, the different criteria catalogues for the diagnosis and classification of systemic lupus erythematosus show different specificity and sensitivity as well as accuracy in the detection and classification of the disease. Nevertheless, all four systems examined are reliable and suitable for everyday clinical use, and offer treating physicians valuable assistance in making a diagnosis of SLE. 

Source:
Tan BCH, Tang I, Bonin J, Koelmeyer R, Hoi A. The performance of different classification criteria for systemic lupus erythematosus in a real-world rheumatology department. Rheumatology (Oxford). 2022 Feb.