The 1982 revised criteria for the classification of systemic lupus erythematosus
TL;DR: The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunologic knowledge and improve disease classification and showed gains in sensitivity and specificity.
Abstract: The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunologic knowledge and improve disease classification. The 1982 revised criteria include fluorescence antinuclear antibody and antibody to native DNA and Sm antigen. Some criteria involving the same organ systems were aggregated into single criteria. Raynaud's phenomenon and alopecia were not included in the 1982 revised criteria because of low sensitivity and specificity. The new criteria were 96% sensitive and 96% specific when tested with SLE and control patient data gathered from 18 participating clinics. When compared with the 1971 criteria, the 1982 revised criteria showed gains in sensitivity and specificity.
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TL;DR: In 1992, Piette and colleagues suggested that the ACR revised criteria be reevaluated in light of the above discoveries, and the presence and clinical associations or antiphospholipid antibodies in patients with SLE was suggested.
Abstract: In 1982, the Diagnostic and Therapeutic Criteria Committee of the American College of Rheumatology (ACR)published revised criteria for the classification of systemiclupus erythematosus (SLE) (1). During the ensuing decade several investigators, including Drs. Graham Hughes and Donato Alarcon-Segovia, among others, have described the presence and clinical associations or antiphospholipid antibodies in patients with SLE, as well as the occurrence of theprimary antiphospholipid syndrome (2-5). In 1992, Piette and colleagues suggested that the ACR revised criteria be reevaluated in light of the above discoveries (6).
9,999 citations
University of Miami1, New York University2, Stanford University3, University of Michigan4, George Washington University5, Indiana University6, University of Pittsburgh7, Queen's University8, North Shore-LIJ Health System9, Johns Hopkins University10, SUNY Downstate Medical Center11, University of Alabama at Birmingham12, University of Florida13, Harvard University14, Boston University15, Case Western Reserve University16, Washington University in St. Louis17, Menorah Medical Center18, Stony Brook University19, University of Kansas20
TL;DR: Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes and these proposed criteria utilize classification trees, or algorithms.
Abstract: For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or para-articular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.
6,160 citations
University of New South Wales1, Hospital for Special Surgery2, Hokkaido University3, University of Utah4, University of Texas Health Science Center at San Antonio5, Utrecht University6, University of Milan7, Geneva College8, Sheba Medical Center9, University of Brescia10, National and Kapodistrian University of Athens11
TL;DR: This document appraise the existing evidence on clinical and laboratory features of APS addressed during the forum and proposes amendments to the Sapporo criteria, including definitions on features ofAPS that were not included in the updated criteria.
5,699 citations
TL;DR: The study showed the clinical history screening test for AS to be moderately sensitive, but it might be better in clinical practice, and substitution of the Rome pain criterion for the New York pain criterion is proposed.
Abstract: The New York and the Rome diagnostic criteria for ankylosing spondylitis (AS) and the clinical history screening test for AS were evaluated in relatives of AS patients and in population control subjects. The New York criterion of pain in the (dorso) lumbar spine lacks specificity, and the chest expansion criterion is too insensitive. The Rome criterion of low back pain for more than 3 months is very useful. Our study showed the clinical history screening test for AS to be moderately sensitive, but it might be better in clinical practice. As a modification of the New York criteria, substitution of the Rome pain criterion for the New York pain criterion is proposed.
5,143 citations
TL;DR: A fatigue severity scale was internally consistent, correlated well with visual analogue measures, clearly differentiated controls from patients, and could detect clinically predicted changes in fatigue over time and identify features that distinguish fatigue between two chronic medical disorders.
Abstract: • Fatigue is a prominent disabling symptom in a variety of medical and neurologic disorders. To facilitate research in this area, we developed a fatigue severity scale, subjected it to tests of internal consistency and validity, and used it to compare fatigue in two chronic conditions: systemic lupus erythematosus and multiple sclerosis. Administration of the fatigue severity scale to 25 patients with multiple sclerosis, 29 patients with systemic lupus erythematosus, and 20 healthy adults revealed that the fatigue severity scale was internally consistent, correlated well with visual analogue measures, clearly differentiated controls from patients, and could detect clinically predicted changes in fatigue over time. Fatigue had a greater deleterious impact on daily living in patients with multiple sclerosis and systemic lupus erythematosus compared with controls. The results further showed that fatigue was largely independent of self-reported depressive symptoms and that several characteristics could differentiate fatigue that accompanies multiple sclerosis from fatigue that accompanies systemic lupus erythematosus. This study demonstrates (1) the clinical and research applications of a scale that measures fatigue severity and (2) helps to identify features that distinguish fatigue between two chronic medical disorders.
4,974 citations
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TL;DR: A multicenter, ongoing study of early-diagnosed cases of systemic sclerosis and comparison patients with systemic lupus erythematosus, polymyositis/dermatomyositis, and Raynaud's phenomenon was conducted in order to develop classification criteria for systemic sclerosis.
Abstract: A multicenter, ongoing study of early-diagnosed cases of systemic sclerosis and comparison patients with systemic lupus erythematosus, polymyositis/dermatomyositis, and Raynaud's phenomenon was conducted in order to develop classification criteria for systemic sclerosis. Preliminary criteria are proposed, namely, the finding of either the sole major criterion, i.e.,1) sclerodactyly, 2) digital pitting scars of fingertips or loss of substance of the distal finger pad, and 3) bilateral basilar pulmonary fibrosis. When applied to the case and comparison patients included in this study, these proposed criteria had a 97% sensitivity for definite systemic sclerosis and 98% specificity.
4,642 citations
TL;DR: Results show the efficacy of the proposed criteria for early diagnosed patients, and support the inclusion of high titer antinuclear antibody (ANA) in the SLE criteria.
Abstract: Preliminary criteria for the classification of systemic lupus erythematosus (SLE) were applied to patients with early diagnosed SLE and rheumatoid arthritis (RA) who are participants in a prospective community study of arthritis of recent onset. Sensitivity of the criteria was 88%, and specificity against RA was 97.5%. Sensitivity increased to 92% without loss of specificity when high titer antinuclear antibody (ANA) was used as an alternative criteria manifestation to LE cells. These results show the efficacy of the proposed criteria for early diagnosed patients, and support the inclusion of high titer ANA in the SLE criteria.
376 citations
TL;DR: This study evaluates the proposed criteria for the classification of SLE in the context of five questions: (1) How representative was the ARA test patient population?
Abstract: Systemic lupus erythematosus (SLE) is a disease with varied manifestations involving multiple organ systems, accompanied by multiple laboratory abnormalities, and characterized by exacerbations and remissions. Noting that 'uniform classification of defined groups of patients is necessary in order to assemble and compare data from different sources concerning natural history, evaluation of therapy, and epidemologic description', the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association recently approached the formidable task of assembling criteria for the classification of SLE (Cohen, Reynolds, Franklin, Kulka, Ropes, Shulman, and Wallace, 1971). To increase the utility of the criteria in population studies, the use of 'exclusions' and 'duration of manifestations' was avoided. A distinction between 'major' and 'minor' criteria was also not used. Thus, the form of these criteria differs from that of the Jones Criteria for Rheumatic Fever and the ARA Criteria for Rheumatoid Arthritis (Arthritis Foundation, 1964). The committee collected a data base of 245 patients with unequivocal SLE, 234 patients with rheumatoid arthritis, and 217 patients with miscellaneous nonrheumatic diseases. Data was contributed by 52 investigators throughout the United States, who were requested to submit patients with 'unequivocal' SLE, and with 'classic' or 'definite' rheumatoid arthritis. Patients whose clinical course was atypical or in whom diagnostic uncertainty remained were excluded from these two groups. Data was sought on 74 variables of disease considered of potential value for classification. Adequate data was obtained on 57 potential criteria, and the list was reduced to 21 by exclusion of variables which were least useful in distinguishing patients with 'SLE' from 'RA' and 'other' diseases. The final 21 variables were reduced to fourteen 'criteria' by grouping several variables within a single criterion (Table 1, overleaf). The criteria were then tested against the data base, by simple reclassification. A level offour or more positive criteria best distinguished the populations and was recommended by the committee. Tested against the same populations, this level included approximately 90 per cent. ofthe patients with 'SLE' and excluded all but 1 per cent. of the patients with 'rheumatoid arthritis' and all but 2 per cent. of the patients with 'other' diseases. This study evaluates the proposed criteria in the context of five questions: (1) How representative was the ARA test patient population? (2) How adequate are the criteria when tested against an 'outside' patient population? (3) How much does the sensitivity and specificity of the criteria depend upon the point in the course of the patient's illness at which they are applied? (4) How much 'interdependence' is present between various criteria and how much effect does this have on the performance of the criteria? (5) Which diseases might exhibit four or more positive criteria and what percentage of the time may such 'false positives' be expected? Two concepts useful for the testing of criteria are proposed: (1) Testing against a computer-based clinical databank, (2) Testing against 'simulated' patient populations created by computer from known characteristics of the population.
61 citations
TL;DR: Of 38 patients with systemic lupus erythematosus followed in this clinic during the past two years raised levels of anti-DNA antibodies were found in 36 and the recently proposed criteria for the classification of S.L.E. were met in 33 of these 36 patients.
Abstract: Of 38 patients with systemic lupus erythematosus (S.L.E.) followed in this clinic during the past two years raised levels of anti-DNA antibodies were found in 36. The recently proposed criteria for the classification of S.L.E. were met in 33 of these 36 patients. Three patients with raised DNA antibody titres and some of the features of S.L.E. did not meet the criteria for a classification of S.L.E.
44 citations
TL;DR: The use of the Preliminary Criteria for the Classification of Systemic Lupus Erythematosus (SLE) has been reviewed and various suggestions to improve the criteria have been made, including a more detailed description of some of the organ involvements and the adoption of laboratory tests that have been improved since or were unavailable at the time of original publication of the criteria.
Abstract: The use of the Preliminary Criteria for the Classification of Systemic Lupus Erythematosus (SLE) has been reviewed. Most authors describing 10 or more patients have used the criteria. Although originally designed for classification of patients, the criteria have often been used for the diagnosis of SLE. The sensitivity of the criteria was evaluated and found to be similar to the 90% reported in the original ARA trial. Studies on specificity yielded conflicting results. Various suggestions to improve the criteria have been made, including a more detailed description of some of the organ involvements and the adoption of laboratory tests that have been improved since or were unavailable at the time of original publication of the criteria.
32 citations