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 L Brey, Michael H. Weisman, Gerald McGwin, Laurence S. Magder

Research output: Contribution to journalArticle

1444 Citations (Scopus)

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 2012

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Systemic Lupus Erythematosus
Rheumatology
Lupus Nephritis
Antinuclear Antibodies
Allergy and Immunology
Physicians
Biopsy
Antibodies
DNA

ASJC Scopus subject areas

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

Cite this

Petri, M., Orbai, A. M., Alarcõn, G. S., Gordon, C., Merrill, J. T., Fortin, P. R., ... 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

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

In: Arthritis and Rheumatism, Vol. 64, No. 8, 08.2012, p. 2677-2686.

Research output: Contribution to journalArticle

Petri, M, Orbai, AM, Alarcõn, GS, Gordon, C, Merrill, JT, Fortin, PR, Bruce, IN, Isenberg, D, Wallace, DJ, Nived, O, Sturfelt, G, Ramsey-Goldman, R, Bae, SC, Hanly, JG, Sánchez-Guerrero, J, Clarke, A, Aranow, C, Manzi, S, Urowitz, M, Gladman, D, Kalunian, K, Costner, M, Werth, VP, Zoma, A, Bernatsky, S, Ruiz-Irastorza, G, Khamashta, MA, Jacobsen, S, Buyon, JP, Maddison, P, Dooley, MA, Van Vollenhoven, RF, Ginzler, E, Stoll, T, Peschken, C, Jorizzo, JL, Callen, JP, Lim, SS, Fessler, BJ, Inanc, M, Kamen, DL, Rahman, A, Steinsson, K, Franks, AG, Sigler, L, Hameed, S, Fang, H, Pham, N, Brey, RL, Weisman, MH, McGwin, G & Magder, LS 2012, 'Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus', Arthritis and Rheumatism, vol. 64, no. 8, pp. 2677-2686. https://doi.org/10.1002/art.34473
Petri, Michelle ; Orbai, Ana Maria ; Alarcõn, Graciela S. ; Gordon, Caroline ; Merrill, Joan T. ; Fortin, Paul R. ; Bruce, Ian N. ; Isenberg, David ; Wallace, Daniel J. ; Nived, Ola ; Sturfelt, Gunnar ; Ramsey-Goldman, Rosalind ; Bae, Sang Cheol ; Hanly, John G. ; Sánchez-Guerrero, Jorge ; Clarke, Ann ; Aranow, Cynthia ; Manzi, Susan ; Urowitz, Murray ; Gladman, Dafna ; Kalunian, Kenneth ; Costner, Melissa ; Werth, Victoria P. ; Zoma, Asad ; Bernatsky, Sasha ; Ruiz-Irastorza, Guillermo ; Khamashta, Munther A. ; Jacobsen, Soren ; Buyon, Jill P. ; Maddison, Peter ; Dooley, Mary Anne ; Van Vollenhoven, Ronald F. ; Ginzler, Ellen ; Stoll, Thomas ; Peschken, Christine ; Jorizzo, Joseph L. ; Callen, Jeffrey P. ; Lim, S. Sam ; Fessler, Barri J. ; Inanc, Murat ; Kamen, Diane L. ; Rahman, Anisur ; Steinsson, Kristjan ; Franks, Andrew G. ; Sigler, Lisa ; Hameed, Suhail ; Fang, Hong ; Pham, Ngoc ; Brey, Robin L ; Weisman, Michael H. ; McGwin, Gerald ; Magder, Laurence S. / Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. In: Arthritis and Rheumatism. 2012 ; Vol. 64, No. 8. pp. 2677-2686.
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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.",
author = "Michelle Petri and Orbai, {Ana Maria} and Alarc{\~o}n, {Graciela S.} and Caroline Gordon and Merrill, {Joan T.} and Fortin, {Paul R.} and Bruce, {Ian N.} and David Isenberg and Wallace, {Daniel J.} and Ola Nived and Gunnar Sturfelt and Rosalind Ramsey-Goldman and Bae, {Sang Cheol} and Hanly, {John G.} and Jorge S{\'a}nchez-Guerrero and Ann Clarke and Cynthia Aranow and Susan Manzi and Murray Urowitz and Dafna Gladman and Kenneth Kalunian and Melissa Costner and Werth, {Victoria P.} and Asad Zoma and Sasha Bernatsky and Guillermo Ruiz-Irastorza and Khamashta, {Munther A.} and Soren Jacobsen and Buyon, {Jill P.} and Peter Maddison and Dooley, {Mary Anne} and {Van Vollenhoven}, {Ronald F.} and Ellen Ginzler and Thomas Stoll and Christine Peschken and Jorizzo, {Joseph L.} and Callen, {Jeffrey P.} and Lim, {S. Sam} and Fessler, {Barri J.} and Murat Inanc and Kamen, {Diane L.} and Anisur Rahman and Kristjan Steinsson and Franks, {Andrew G.} and Lisa Sigler and Suhail Hameed and Hong Fang and Ngoc Pham and Brey, {Robin L} and Weisman, {Michael H.} and Gerald McGwin and Magder, {Laurence S.}",
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TY - JOUR

T1 - Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus

AU - Petri, Michelle

AU - Orbai, Ana Maria

AU - Alarcõn, Graciela S.

AU - Gordon, Caroline

AU - Merrill, Joan T.

AU - Fortin, Paul R.

AU - Bruce, Ian N.

AU - Isenberg, David

AU - Wallace, Daniel J.

AU - Nived, Ola

AU - Sturfelt, Gunnar

AU - Ramsey-Goldman, Rosalind

AU - Bae, Sang Cheol

AU - Hanly, John G.

AU - Sánchez-Guerrero, Jorge

AU - Clarke, Ann

AU - Aranow, Cynthia

AU - Manzi, Susan

AU - Urowitz, Murray

AU - Gladman, Dafna

AU - Kalunian, Kenneth

AU - Costner, Melissa

AU - Werth, Victoria P.

AU - Zoma, Asad

AU - Bernatsky, Sasha

AU - Ruiz-Irastorza, Guillermo

AU - Khamashta, Munther A.

AU - Jacobsen, Soren

AU - Buyon, Jill P.

AU - Maddison, Peter

AU - Dooley, Mary Anne

AU - Van Vollenhoven, Ronald F.

AU - Ginzler, Ellen

AU - Stoll, Thomas

AU - Peschken, Christine

AU - Jorizzo, Joseph L.

AU - Callen, Jeffrey P.

AU - Lim, S. Sam

AU - Fessler, Barri J.

AU - Inanc, Murat

AU - Kamen, Diane L.

AU - Rahman, Anisur

AU - Steinsson, Kristjan

AU - Franks, Andrew G.

AU - Sigler, Lisa

AU - Hameed, Suhail

AU - Fang, Hong

AU - Pham, Ngoc

AU - Brey, Robin L

AU - Weisman, Michael H.

AU - McGwin, Gerald

AU - Magder, Laurence S.

PY - 2012/8

Y1 - 2012/8

N2 - 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.

AB - 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.

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