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New classification criteria for systemic lupus erythematosus correlate with disease activity.

Anić F, Zuvić-Butorac M, Stimac D, Novak S - Croat. Med. J. (2014)

Bottom Line: The number of SLICC classification criteria met per patient was significantly higher than the number of ACR criteria (7 [IQR 6-8] vs 5 [IQR 4-6], P < 0.001).We neither found a correlation between the number of ACR criteria and disease activity nor between disease activity and disease duration.Patients with longer disease duration had a larger damage index score.

View Article: PubMed Central - PubMed

Affiliation: Felina Anić, Department of Rheumatology and Clinical Immunology, Division of Internal Medicine, University Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia, inaanic@yahoo.com.

ABSTRACT

Aim: To determine the prevalence of American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) classification criteria among systemic lupus erythematosus (SLE) patients; to determine disease activity and severity; and to investigate the correlation of classification criteria with disease activity, and of disease activity and damage index with disease duration.

Methods: We performed a cross-sectional study on 110 SLE patients from the Division of Rheumatology and Clinical Immunology, University Hospital Centre Rijeka, Croatia in the period from September to December 2013 and determined disease duration and the total number of ACR and SLICC classification criteria. Disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) index and organ damage by Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index.

Results: The number of SLICC classification criteria met per patient was significantly higher than the number of ACR criteria (7 [IQR 6-8] vs 5 [IQR 4-6], P < 0.001). Moderate correlations were detected between the number of SLICC classification criteria and disease activity index, both in case of active (r=0.48, P=0.003) and inactive disease (r=0.43, P < 0.001). We neither found a correlation between the number of ACR criteria and disease activity nor between disease activity and disease duration. However, there was a good correlation between SLICC/ACR damage index and disease duration (r=0.63, P < 0.001).

Conclusion: New SLICC classification criteria correlate with disease activity because they capture more manifestations also included in the SLEDAI index. Patients with longer disease duration had a larger damage index score.

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The prevalence of the American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus (SLE) in 110 SLE patients.
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Figure 1: The prevalence of the American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus (SLE) in 110 SLE patients.

Mentions: The prevalence of each ACR classification criterion (Figure 1) and new SLICC criterion (Figure 2) for SLE was determined and the most frequently observed criteria were positive ANA titer (in 94% of patients), immunologic disorder (91%), arthritis (90%), anti-dsDNA (85%), low complement (85%), hematologic disorder (79%), leukopenia (78%), and acute cutaneous lupus (73%). For 11 (10%) SLE patients, there were no data about anticardiolipin antibodies. Median number of ACR classification criteria met per patient was 5 (IQR 4-6) and of SLICC classification criteria was 7 (IQR 6-8) (Mann-Whitney U test, P < 0.001). Thirty-six patients (33%) had active SLE (SELENA SLEDAI score ≥6). Median SELENA SLEDAI score of all patients was 2 (IQR 0-7), while median SELENA SLEDAI score of patients with active SLE was 8 (IQR 7-10). We found no correlation between ACR classification criteria and SELENA SLEDAI score either in active (r = 0.23, P = 0.173) or inactive (r = 0.24, P = 0.041) disease. However, moderate correlations were detected between SLICC classification criteria and disease activity index, both in active (r = 0.48, P = 0.003) and inactive disease (r = 0.43, P < 0.001) (Table 1). The most frequently observed clinical and laboratory components of SELENA SLEDAI index were low complement in 53%, increased DNA binding in 35%, arthritis in 27%, and rash in 15% of patients (Figure 3). Median SLICC/ACR damage index score of all patients was 2 (IQR 0-3). The most frequently observed components were osteoporosis with fracture or vertebral collapse and cranial or peripheral neuropathy in 22%, any cataract ever in 21%, pleural fibrosis in 13%, and malignant diseases in 12% of patients (Figure 4). Among SLE patients with malignant diseases we recorded 4 gynecologic cancers, 2 breast cancers, 1 melanoma, 1 basalioma, 1 kidney cancer, 1 lung cancer, 1 myeloproliferative neoplasm, 1 Hürthle cell cancer, and 1 metastatic brain tumor. This group had significantly longer disease duration than patients without malignant diseases (median 15 years [IQR 9-20] vs 9 years [IQR 5-13], P = 0.042). The correlation between activity score index and duration of disease was not found (r = -0.13, P = 0.172), although a good correlation between disease duration and SLICC/ACR damage index was recorded (r = 0.63, P < 0.001).


New classification criteria for systemic lupus erythematosus correlate with disease activity.

Anić F, Zuvić-Butorac M, Stimac D, Novak S - Croat. Med. J. (2014)

The prevalence of the American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus (SLE) in 110 SLE patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228292&req=5

Figure 1: The prevalence of the American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus (SLE) in 110 SLE patients.
Mentions: The prevalence of each ACR classification criterion (Figure 1) and new SLICC criterion (Figure 2) for SLE was determined and the most frequently observed criteria were positive ANA titer (in 94% of patients), immunologic disorder (91%), arthritis (90%), anti-dsDNA (85%), low complement (85%), hematologic disorder (79%), leukopenia (78%), and acute cutaneous lupus (73%). For 11 (10%) SLE patients, there were no data about anticardiolipin antibodies. Median number of ACR classification criteria met per patient was 5 (IQR 4-6) and of SLICC classification criteria was 7 (IQR 6-8) (Mann-Whitney U test, P < 0.001). Thirty-six patients (33%) had active SLE (SELENA SLEDAI score ≥6). Median SELENA SLEDAI score of all patients was 2 (IQR 0-7), while median SELENA SLEDAI score of patients with active SLE was 8 (IQR 7-10). We found no correlation between ACR classification criteria and SELENA SLEDAI score either in active (r = 0.23, P = 0.173) or inactive (r = 0.24, P = 0.041) disease. However, moderate correlations were detected between SLICC classification criteria and disease activity index, both in active (r = 0.48, P = 0.003) and inactive disease (r = 0.43, P < 0.001) (Table 1). The most frequently observed clinical and laboratory components of SELENA SLEDAI index were low complement in 53%, increased DNA binding in 35%, arthritis in 27%, and rash in 15% of patients (Figure 3). Median SLICC/ACR damage index score of all patients was 2 (IQR 0-3). The most frequently observed components were osteoporosis with fracture or vertebral collapse and cranial or peripheral neuropathy in 22%, any cataract ever in 21%, pleural fibrosis in 13%, and malignant diseases in 12% of patients (Figure 4). Among SLE patients with malignant diseases we recorded 4 gynecologic cancers, 2 breast cancers, 1 melanoma, 1 basalioma, 1 kidney cancer, 1 lung cancer, 1 myeloproliferative neoplasm, 1 Hürthle cell cancer, and 1 metastatic brain tumor. This group had significantly longer disease duration than patients without malignant diseases (median 15 years [IQR 9-20] vs 9 years [IQR 5-13], P = 0.042). The correlation between activity score index and duration of disease was not found (r = -0.13, P = 0.172), although a good correlation between disease duration and SLICC/ACR damage index was recorded (r = 0.63, P < 0.001).

Bottom Line: The number of SLICC classification criteria met per patient was significantly higher than the number of ACR criteria (7 [IQR 6-8] vs 5 [IQR 4-6], P < 0.001).We neither found a correlation between the number of ACR criteria and disease activity nor between disease activity and disease duration.Patients with longer disease duration had a larger damage index score.

View Article: PubMed Central - PubMed

Affiliation: Felina Anić, Department of Rheumatology and Clinical Immunology, Division of Internal Medicine, University Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia, inaanic@yahoo.com.

ABSTRACT

Aim: To determine the prevalence of American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) classification criteria among systemic lupus erythematosus (SLE) patients; to determine disease activity and severity; and to investigate the correlation of classification criteria with disease activity, and of disease activity and damage index with disease duration.

Methods: We performed a cross-sectional study on 110 SLE patients from the Division of Rheumatology and Clinical Immunology, University Hospital Centre Rijeka, Croatia in the period from September to December 2013 and determined disease duration and the total number of ACR and SLICC classification criteria. Disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) index and organ damage by Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index.

Results: The number of SLICC classification criteria met per patient was significantly higher than the number of ACR criteria (7 [IQR 6-8] vs 5 [IQR 4-6], P < 0.001). Moderate correlations were detected between the number of SLICC classification criteria and disease activity index, both in case of active (r=0.48, P=0.003) and inactive disease (r=0.43, P < 0.001). We neither found a correlation between the number of ACR criteria and disease activity nor between disease activity and disease duration. However, there was a good correlation between SLICC/ACR damage index and disease duration (r=0.63, P < 0.001).

Conclusion: New SLICC classification criteria correlate with disease activity because they capture more manifestations also included in the SLEDAI index. Patients with longer disease duration had a larger damage index score.

Show MeSH
Related in: MedlinePlus