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Abstract Number: 0270

The New EULAR/ ACR 2019 SLE Classification Criteria: Defining Ominosity in SLE

Laura Whittall-Garcia1, Dafna Gladman2, Murray Urowitz3, Jiandong Su4 and Sindhu Johnson5, 1University Health Network, Toronto, ON, Canada, 2Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada, 3University Health Network, University of Toronto, Toronto, ON, Canada, 4University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, University Health Network, Toronto, ON, Canada, 5University of Toronto, Toronto, ON, Canada

Meeting: ACR Convergence 2020

Keywords: classification criteria, Systemic lupus erythematosus (SLE)

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Session Information

Date: Friday, November 6, 2020

Session Title: SLE – Diagnosis, Manifestations, & Outcomes Poster I: Clinical Manifestations

Session Type: Poster Session A

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

Background/Purpose: SLE is characterized by different patterns of disease activity throughout its course. Overall, a higher disease activity is an important predictor of mortality and damage accrual.

Recently, a new set of classification criteria for SLE using an additive point system has been introduced, the 2019 EULAR/ACR classification criteria (EULAR/ACR) which have proven to be sensitive and specific. Furthermore, these criteria have correlated with SLEDAI and SLAM-R scores at diagnosis. In a different cohort, higher EULAR/ACR scores were associated with higher rates of organ damage.

We aimed to determine the ominosity of the EULAR/ACR by determining their potential predictive role for disease severity in the first 5 years of disease course.

Methods: Inception SLE patients (recruited in the first 12 months after diagnosis) were included.

For each patient a score of the EULAR/ACR was calculated based on the baseline clinical and laboratory information. The baseline information was obtained from the first 2 visits as some of the data and therapies ordered at the first visit were recorded only at the second visit.

To determine the ominosity of the EULAR/ACR, we used outcomes to establish disease severity over the first 5 years after diagnosis including Adjusted mean SLEDAI-2K (AMS), flares, remission and use of immunosuppressive treatment. 

Results: A total of 867 inception patients were included, 87.5% were woman, with a mean age of 36.2 years at baseline. Most patients were Caucasians (66.7%), followed by Blacks (14.2%).

The mean disease duration (time between diagnosis and first visit) was 0.2 years, the median time between the first visit and the second visit was 3.3 months.

The median EULAR/ACR score was 20. We used this score as a threshold to compare demographic, clinical characteristics and outcomes between groups. Fig 1.

Blacks more frequently presented with a score ≥ 20 compared to Caucasians. At baseline patients with a score ≥ 20 were younger, had higher SLEDAI-2K scores and were more likely to receive immunosuppressive therapy. Table 1.  

In the first 5 years of disease course, patients with a score ≥ 20 had higher AMS scores. Every increase of 10 points in the score increased the AMS by 2.2 units (Univariate Linear regression, beta = 0.22, p< .0001). Likewise, patients with a higher score were more likely to ever present with a flare and more frequently experienced ≥2 flares. Every 10 points increase in the score increased the risk of a flare by 32% (RR: 1.32 95%CI: 1.173, 1.485, p < .0001) Table 1. Looking at specific organ flares this group presented more renal (31.6% vs 12.8%, ≥20 vs < 20, p=< 0.001) and hematologic (8% vs 2.2%, ≥20 vs < 20, p=0.007) flares.

In addition, these patients were less likely to achieve remission, Fig. 2 and had higher requirements for immunosuppressive therapy. Table 1.

Conclusion: Overall, EULAR/ACR score ≥20 is an indicator of ominosity in the SLE disease course. SLE patients with a score ≥20 were characterized by higher disease activity throughout the first 5 years after diagnosis. Thus, the new classification criteria could be helpful not only in classifying SLE cases but could also provide prognostic information regarding the disease course in the first 5 years following diagnosis.


Disclosure: L. Whittall-Garcia, None; D. Gladman, AbbVie, 2, 5, Amgen, 2, 5, Janssen, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, UCB, 2, 5, Bristol-Myers Squibb, 5, Gilead, 5, Galapagos, 5, Celgene, 2, 5, Eli Lilly, 2, 5; M. Urowitz, None; J. Su, None; S. Johnson, None.

To cite this abstract in AMA style:

Whittall-Garcia L, Gladman D, Urowitz M, Su J, Johnson S. The New EULAR/ ACR 2019 SLE Classification Criteria: Defining Ominosity in SLE [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/the-new-eular-acr-2019-sle-classification-criteria-defining-ominosity-in-sle/. Accessed January 15, 2021.
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