A comparison and review of three sets of classification criteria for systemic lupus erythematosus for distinguishing systemic lupus erythematosus from pure mucocutaneous manifestations in the lupus disease spectrum

Hui Jin; Tao Huang; Ruifang Wu; Ming Zhao; Haijing Wu; Hai Long; Heng Yin; Jieyue Liao; Shuangyan Luo; Yu Liu; Qing Zhang; Peng Zhang; Yixin Tan; Shuaihantian Luo; Xin Huang; Yaxiong Deng; Wei Liao; Liu Duan; Jianbo Chen; Yin Zhou; Jinghua Yin; Hong Qiu; Jin Yuan; Zijun Wang; Mengying Li; Xiaoqi Wu; Lina Chen; Liangmin Cai; Cancan Huang; Qianwen Li; Bingsi Tang; Bihui Yu; Xin Li; Xiaofei Gao; Yixi Hu; Xiaolei Ren; Haofan Xue; Zhangming Wei; Jinwei Chen; Fen Li; Guanghui Ling; Hui Luo; Hongjun Zhao; Sen Yang; Yong Cui; Youkun Lin; Xu Yao; Lingyun Sun; Qing Guo; Hong Fang; Kang Zeng; Danqi Deng; Jianzhong Zhang; Yuzhen Li; Xiongming Pu; Xiangping Liao; Xiqiang Dang; Danlin Huang; Yumei Liang; Qing Sun; Hongju Xie; Li Zeng; Cibo Huang; Qingchun Diao; Juan Tao; Jianbin Yu; Zhenlu Li; Hanshi Xu; Hui Li; Wei Lai; Xiguang Liu; Jingjing Wu; Tienan Li; Tiechi Lei; Qiuning Sun; Yanjia Li; Guoqiang Zhang; Xin Huang; Qianjin Lu

doi:10.1177/0961203320959716

A comparison and review of three sets of classification criteria for systemic lupus erythematosus for distinguishing systemic lupus erythematosus from pure mucocutaneous manifestations in the lupus disease spectrum

Lupus. 2020 Dec;29(14):1854-1865. doi: 10.1177/0961203320959716. Epub 2020 Oct 7.

Authors

Hui Jin^{1

2}, Tao Huang^{1

2}, Ruifang Wu^{1

2}, Ming Zhao^{1

2}, Haijing Wu^{1

2}, Hai Long^{1

2}, Heng Yin^{1

2}, Jieyue Liao^{1

2}, Shuangyan Luo^{1

2}, Yu Liu^{1

2}, Qing Zhang^{1

2}, Peng Zhang^{1

2}, Yixin Tan^{1

2}, Shuaihantian Luo^{1

2}, Xin Huang^{1

2}, Yaxiong Deng^{1

2}, Wei Liao^{1

2}, Liu Duan^{1

2}, Jianbo Chen^{1

2}, Yin Zhou^{1

2

3}, Jinghua Yin^{1

2}, Hong Qiu^{1

2}, Jin Yuan^{1

2}, Zijun Wang^{1

2}, Mengying Li^{1

2}, Xiaoqi Wu^{1

2}, Lina Chen^{1

2}, Liangmin Cai^{1

2}, Cancan Huang^{1

2}, Qianwen Li^{1

2}, Bingsi Tang^{1

2}, Bihui Yu^{1

2}, Xin Li^{1

2}, Xiaofei Gao^{1

2}, Yixi Hu^{1

2}, Xiaolei Ren^{1

2}, Haofan Xue^{1

2}, Zhangming Wei^{1

2}, Jinwei Chen⁴, Fen Li⁴, Guanghui Ling⁴, Hui Luo⁵, Hongjun Zhao⁵, Sen Yang⁶, Yong Cui⁷, Youkun Lin⁸, Xu Yao⁹, Lingyun Sun¹⁰, Qing Guo¹¹, Hong Fang¹², Kang Zeng¹³, Danqi Deng¹⁴, Jianzhong Zhang¹⁵, Yuzhen Li¹⁶, Xiongming Pu¹⁷, Xiangping Liao¹⁸, Xiqiang Dang¹⁹, Danlin Huang¹⁹, Yumei Liang²⁰, Qing Sun²¹, Hongju Xie²², Li Zeng²², Cibo Huang²³, Qingchun Diao²⁴, Juan Tao²⁵, Jianbin Yu²⁶, Zhenlu Li²⁷, Hanshi Xu²⁸, Hui Li²⁹, Wei Lai³⁰, Xiguang Liu³¹, Jingjing Wu³², Tienan Li³³, Tiechi Lei³⁴, Qiuning Sun³⁵, Yanjia Li³⁶, Guoqiang Zhang³⁶, Xin Huang³⁷, Qianjin Lu^{1

2}

Affiliations

¹ Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China.
² Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China.
³ Department of Medical CosmetoIogy, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China.
⁴ Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, China.
⁵ Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China.
⁶ Department of Dermatology, Institute of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.
⁷ Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.
⁸ Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
⁹ Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
¹⁰ Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
¹¹ Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
¹² Department of Dermatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
¹³ Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
¹⁴ Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
¹⁵ Department of Dermatology, Peking University People's Hospital, Beijing, China.
¹⁶ Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
¹⁷ Department of Dermatology, The People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, China.
¹⁸ Department of nephropathy and Rheumatology, The First People's Hospital of ChenZhou, ChenZhou, China.
¹⁹ Laboratory of Children's Kidney Disease, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China.
²⁰ Department of Nephropathy and Rheumatology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
²¹ Department of Dermatology, Qilu Hospital of Shandong University, Jinan, China.
²² Department of Medical cosmetology, First Affiliated Hospital, University of South China, Hengyang, China.
²³ Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Beijing, China.
²⁴ Department of Dermatology, Chongqing Traditional Chinese Medicine Hospital, Chongqing First People's Hospital, Chongqing, China.
²⁵ Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.
²⁶ Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
²⁷ Department of Dermatology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China.
²⁸ Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
²⁹ Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
³⁰ Department of Dermatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
³¹ Department of Dermatology, Heilongjiang Provincial Hospital, Harbin, China.
³² Department of Dermatology, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China.
³³ Department of Dermatology, the Seventh People's Hospital of Shenyang, Shenyang, China.
³⁴ Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China.
³⁵ Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³⁶ Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China.
³⁷ Department of epidemiology, Medical School of Hunan Normal University, Changsha, China.

PMID: 33028176
DOI: 10.1177/0961203320959716

Abstract

Although the original purpose of the systemic lupus erythematosus (SLE) classification criteria was to distinguish SLE from other mimic diseases, and to facilitate sample selection in scientific research, they have become widely used as diagnostic criteria in clinical situations. It is not known yet if regarding classification criteria as diagnostic criteria, what problems might be encountered? This is the first study comparing the three sets of classification criteria for SLE, the 1997 American College of Rheumatology (ACR'97), 2012 Systemic Lupus International Collaborating Clinics (SLICC'12) and 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR'19), for their ability to distinguish patients with SLE from patients with pure mucocutaneous manifestations (isolated cutaneous lupus erythematosus without internal disease, i-CLE) in the lupus disease spectrum. 1,865 patients with SLE and 232 patients with i-CLE were recruited from a multicenter study. We found that, due to low specificity, none of the three criteria are adept at distinguishing patients with SLE from patients with i-CLE. SLICC'12 performed best among the original three criteria, but if a positive ANA was removed as an entry criterion, EULAR/ACR'19 would performed better. A review of previous studies that compared the three sets of criteria was presented in this work.

Keywords: American College of Rheumatology; Cutaneous lupus erythematosus; European League Against Rheumatism; Systemic Lupus International Collaborating Clinics; classification criteria; systemic lupus erythematosus.

Publication types

Comparative Study

MeSH terms

Adult
Antibodies, Antinuclear / blood
Diagnosis, Differential
Female
Humans
Lupus Erythematosus, Cutaneous / diagnosis*
Lupus Erythematosus, Systemic / diagnosis*
Male
Middle Aged
Rheumatology / methods
Sensitivity and Specificity
Societies, Medical

Substances

Antibodies, Antinuclear