Associations Among Classification Criteria Items within Systemic Lupus Erythematosus

Zahi Touma¹, Ricard Cervera², Ralph Brinks³, Chiara Tani⁴, Bimba F. Hoyer⁵, Karen H. Costenbader⁶, Valentina Lorenzoni⁷, Gian Sebastiani⁸, Sandra V. Navarra⁹, Eloisa Bonfa¹⁰, Rosalind Ramsey-Goldman¹¹, Sara K. Tedeschi¹², Thomas Doerner¹³, Sindhu Johnson¹⁴, Martin Aringer¹⁵ and Marta Mosca¹⁶, ¹Rheumatology, University of Toronto, Division of Rheumatology, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada, ²Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain, ³Hiller Center for Research in Rheumatology, Dusseldorf, Germany, ⁴University of Pisa, Pisa, Italy, ⁵Charité University Medicine, Department of Medicine/Rheumatology and Clinical Immunology and German Rheumatism Research Centre Berlin (DRFZ), Berlin, Germany, ⁶Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, ⁷Sant Anna Scuola Universitaria Superiore Pisa, Pisa, Italy, ⁸Ospedale San Camillo, Rome, Italy, ⁹Rheumatology, University of Santo Tomas Hospital, Manila, Philippines, ¹⁰Rheumatology Divison, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ¹¹FSM, Northwestern University, Chicago, IL, ¹²Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, ¹³Charité Universitätmedizin Berlin and DRFZ, Berlin, Germany, ¹⁴Division of Rheumatology, University of Toronto, Toronto Scleroderma Program, Sinai Health Systems and University Health Network, Toronto, ON, Canada, ¹⁵Medicine III, University Medical Center and Faculty of Medicine at the TU Dresden, Dresden, Germany, ¹⁶Rheumatology Unit, University of Pisa, Pisa, Italy

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: classification criteria and systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 6, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

An EULAR/ACR –sponsored project is currently developing new weighted SLE classification criteria including laboratory/clinical items. Combinations of symptoms appear commonly in SLE arguing against lupus as one single disease entity. Moreover, if such “clusters (buckets)” exist this would distort the weightings. It is important to ensure the independence of potential criteria items from each other. We evaluated the interrelationship between candidate criteria items in 2 cohorts.

Methods:

International Early SLE Cohort: 389 SLE patients diagnosed within the last 3 years, from 7 academic centers in Asia (Manila), Europe (Berlin, Pisa), North America (Boston, Chicago, Toronto) and South America (São Paulo). Data on all ACR 1997, SLICC 2012 and 30 additional items were collected.

Tetrachoric correlation coefficients (rho) assessed the association between different items of the same domain (rho 0.2-0.3 borderline and rho > 0.3 meaningful correlation). Mucocutaneous, hematologic and neurological items were examined to avoid overrepresentation.

Euro-Lupus Cohort: 1000 SLE patients from 12 universities (7 European countries). The baseline patient data set was used for the analysis. The complete correlation matrix of the Euro-Lupus clinical data was analyzed. The significant associations identified in the international cohort were validated in the Euro-Lupus cohort.

Results:

Mucocutaneous items: Only malar rash resulted in a correlation ≥ 0.2 with photosensitivity, alopecia, and oral ulcers. Neurological items: Only seizure and the non-criteria symptom migraine showed a correlation ≥ 0.2. Serologic items: A high degree of correlation was found for anti-Sm with anti-RNP, and anti-dsDNA, for anti-Ro with anti-La, and between anti-phospholipid antibodies. Other correlations are represented in Table 1.

With the exception of the correlation between malar rash and oral ulcers, all associations between mucocutaneous manifestations were independently confirmed in the Euro-Lupus cohort.

Correlation matrix of the Euro-Lupus cohort: rho ≥ 0.2 were only found for fever with alopecia and with nephritis, for lymphadenopathy with fever and with hepatitis, and for Libman-Sacks endocarditis with cardiomyopathy (Figure 1).

Conclusion: Significant associations were observed among specific clinical and serologic criteria items in the international cohort, and these results were externally validated in the Euro-Lupus cohort. These results will be considered in the ongoing development of new SLE classification criteria.

Table 1. Correlation with rho ≥ 0.2 among cutaneous manifestations, neurological and serologic in the international early SLE cohort
Manifestations	Items	Tetrachoric rho International cohort
Mucocutaneous	Malar rash vs alopecia	0.250
	Malar rash vs photosensitivity	0.299
	Malar rash vs oral ulcer	0.216
Neuro	Seizure vs Migraine	0.217
Serologic	Anti-Sm vs Anti-dsDNA	0.334
	Anti-Sm vs anti-Ro	0.240
	Anti-Sm vs anti-RNP	0.606
	Anti-Ro vs anti-La	0.541
	Anti-Cardiolipin IgG vs IgM	0.382
	Anti-Cardiolipin IgG vs LAC	0.286
	Anti-Cardiolipin IgG vs anti-beta2-GPI	0.510
	Anti-Cardiolipin IgM vs anti-beta2-GPI	0.403
	LAC vs anti-beta2-GPI	0.256
	Anti-dsDNA vs anti-cardiolipin IgM	0.219
	Anti-dsDNA vs anti-cardiolipin IgM	0.219
All p were < 0.001 List of all studied items but not represented in this table: Discoid rash, subacute rash, stroke, transitory attack, cognitive impairment, seizure, psychosis, migraine, and ANA.

Disclosure: Z. Touma, None; R. Cervera, None; R. Brinks, None; C. Tani, None; B. F. Hoyer, None; K. H. Costenbader, None; V. Lorenzoni, None; G. Sebastiani, None; S. V. Navarra, None; E. Bonfa, None, 2; R. Ramsey-Goldman, None; S. K. Tedeschi, None; T. Doerner, None; S. Johnson, None; M. Aringer, None; M. Mosca, None.

To cite this abstract in AMA style:

Touma Z, Cervera R, Brinks R, Tani C, Hoyer BF, Costenbader KH, Lorenzoni V, Sebastiani G, Navarra SV, Bonfa E, Ramsey-Goldman R, Tedeschi SK, Doerner T, Johnson S, Aringer M, Mosca M. Associations Among Classification Criteria Items within Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/associations-among-classification-criteria-items-within-systemic-lupus-erythematosus/. Accessed .

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/associations-among-classification-criteria-items-within-systemic-lupus-erythematosus/