Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: The SLICC group has proposed a modification of the revised/updated SLE ACR classification criteria; it has comparable metric properties but is felt to be clinically more relevant (Arthritis Rheum 2012, May 2, ePub ahead of print). We have now compared both sets of criteria in a well-characterized SLE cohort.
Methods: At cohort entry (V0), all patients had met 4 updated/revised ACR criteria. Using the data up to V0, we determined the dates at which the ACR and SLICC criteria were first met. Some SLICC criteria could not be applied (some acute and chronic forms of cutaneous lupus, non-scarring alopecia, mononeuritis multiplex and complement values). We compared groups of patients based on whether the SLICC criteria were met before, at the same time or after the ACR were met.
Results: Of 640, using the SLICC criteria 319 (49.8%) were classified at the same time using either criteria set, 78 earlier (12.2%, mean 0.7 years) and 225 (35%) later (mean 4.4 years) compared to the ACR criteria; 18 patients (2.8%) did not meet the SLICC criteria despite a mean of 1.2 years from the time the ACR criteria were met and V0. Five of the 78 earlier patients (6.4%) met the SLICC rule of lupus nephritis (LN) plus 1 immunologic criterion. Of the patients diagnosed later, the majority did so because of the combination of malar rash and photosensitivity into the Acute Cutaneous Lupus criterion. There were no differences in terms of age, gender and disease activity between the groups, but African Americans and Texan-Hispanics were more likely to be in the no difference group and Caucasians and Puerto Rican-Hispanics in the later or in the no diagnosis groups. Tables 1 and 2 show the distribution of the ACR and SLICC criteria among all 4 groups; only those criteria which differ between the 2 sets are shown in Table 2.
Conclusion: Despite the lack of data for some of the items on the SLICC criteria, we have shown that some patients could be classified earlier with them than with the ACR criteria (major organ involvement or LN plus 1 immunologic criterion); however, a relatively high proportion of patients could not be classified until later (malar rash/ photosensitivity combination in 1 criterion, main reason) or not at all. Longitudinally complete data collection is needed to better define the role of the SLICC criteria in the clinical and research settings.
Table 1. Patients who met ACR Criteria at V0
|
ACR criteria |
N (positive) |
SLICC criteria met earlier, % n=78 |
SLICC criteria met later, %, n=225 |
SLICC criteria not met, % n=18 |
SLICC criteria met at the same time, % n=319 |
p-value |
|
Malar rash |
316 |
30.8 |
57.3 |
88.9 |
46.1 |
<0.001 |
|
Discoid rash |
76 |
9.0 |
11.1 |
11.1 |
13.2 |
0.757 |
|
Photosensitivity |
332 |
48.7 |
64.9 |
100.0 |
40.8 |
<0.001 |
|
Oral ulcers |
263 |
38.5 |
39.6 |
44.4 |
42.6 |
0.785 |
|
Synovitis |
484 |
74.4 |
76.0 |
61.1 |
76.5 |
0.506 |
|
Serositis |
265 |
28.2 |
35.1 |
5.6 |
51.1 |
<0.001 |
|
Neurologic |
59 |
5.1 |
4.4 |
5.6 |
13.8 |
<0.001 |
|
Renal |
202 |
29.5 |
24.4 |
5.6 |
38.6 |
<0.001 |
|
Hematologic |
437 |
70.5 |
60.0 |
27.8 |
75.9 |
<0.001 |
|
Immunologic |
451 |
65.4 |
59.1 |
5.6 |
83.4 |
<0.001 |
|
ANA |
621 |
100.0 |
99.1 |
55.6 |
97.2 |
<0.001 |
Table 2. SLICC Criteria in SLE Patients at V0
|
Clinical
|
N (positive) |
SLICC criteria met earlier, % n=78 |
SLICC Criteria met later, %, n=225 |
SLICC criteria not met, % n=18 |
SLICC criteria met at the same time, % n=319 |
p-value |
|
Acute cutaneous lupus or SCLE |
419 |
57.7 |
72.4 |
100.0 |
60.5 |
<0.001
|
|
Neurologic |
76 |
11.5 |
4.9 |
11.1 |
16.9 |
<0.001 |
|
Hemolytic anemia |
59 |
10.3 |
5.3 |
5.6 |
11.9 |
0.067 |
|
Leukopenia |
464 |
85.9 |
62.2 |
27.8 |
79.0 |
<0.001 |
|
Thrombocytopenia |
104 |
12.8 |
7.1 |
0 |
24.5 |
<0.001 |
|
Immunologic
|
|
|
|
|
|
|
|
Anti-DNA |
427 |
83.3 |
52.9 |
5.6 |
75.9 |
<0.001 |
|
Anti-Sm |
290 |
73.1 |
24.0 |
0 |
56.1 |
<0.001 |
|
Anti-phospholipid |
186 |
47.4 |
14.2 |
0 |
36.7 |
<0.001 |
Disclosure:
G. S. Alarcon,
None;
G. McGwin Jr.,
None;
L. Madger,
None;
M. Petri,
HGS,
5,
GlaxoSmithKline,
5,
Medimmune,
5,
UCB,
5,
Anthera,
5,
Pfizer Inc,
5.
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