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

Michelle Petri, Ana Maria Orbai, Graciela S. Alarcõn, Caroline Gordon, Joan T. Merrill, Paul R. Fortin, Ian N. Bruce, David Isenberg, Daniel J. Wallace, Ola Nived, Gunnar Sturfelt, Rosalind Ramsey-Goldman, Sang Cheol Bae, John G. Hanly, Jorge Sánchez-Guerrero, Ann Clarke, Cynthia Aranow, Susan Manzi, Murray Urowitz, Dafna GladmanKenneth Kalunian, Melissa Costner, Victoria P. Werth, Asad Zoma, Sasha Bernatsky, Guillermo Ruiz-Irastorza, Munther A. Khamashta, Soren Jacobsen, Jill P. Buyon, Peter Maddison, Mary Anne Dooley, Ronald F. Van Vollenhoven, Ellen Ginzler, Thomas Stoll, Christine Peschken, Joseph L. Jorizzo, Jeffrey P. Callen, S. Sam Lim, Barri J. Fessler, Murat Inanc, Diane L. Kamen, Anisur Rahman, Kristjan Steinsson, Andrew G. Franks, Lisa Sigler, Suhail Hameed, Hong Fang, Ngoc Pham, Robin Brey, Michael H. Weisman, Gerald McGwin, Laurence S. Magder

Research output: Contribution to journalArticle

1619 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2677-2686
Number of pages10
JournalArthritis and rheumatism
Volume64
Issue number8
DOIs
StatePublished - Aug 1 2012

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ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Pharmacology (medical)

Cite this

Petri, M., Orbai, A. M., Alarcõn, G. S., Gordon, C., Merrill, J. T., Fortin, P. R., Bruce, I. N., Isenberg, D., Wallace, D. J., Nived, O., Sturfelt, G., Ramsey-Goldman, R., Bae, S. C., Hanly, J. G., Sánchez-Guerrero, J., Clarke, A., Aranow, C., Manzi, S., Urowitz, M., ... Magder, L. S. (2012). Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis and rheumatism, 64(8), 2677-2686. https://doi.org/10.1002/art.34473