Dr. Fortin has received consulting fees, speaking fees, and/or honoraria from GlaxoSmithKline (less than $10,000).
Systemic Lupus Erythematosus
Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus
Article first published online: 27 JUL 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 64, Issue 8, pages 2677–2686, August 2012
How to Cite
Petri, M., Orbai, A.-M., Alarcón, G. S., Gordon, C., Merrill, J. T., Fortin, P. R., Bruce, I. N., Isenberg, D., Wallace, D. J., Nived, O., Sturfelt, G., Ramsey-Goldman, R., Bae, S.-C., Hanly, J. G., Sánchez-Guerrero, J., Clarke, A., Aranow, C., Manzi, S., Urowitz, M., Gladman, D., Kalunian, K., Costner, M., Werth, V. P., Zoma, A., Bernatsky, S., Ruiz-Irastorza, G., Khamashta, M. A., Jacobsen, S., Buyon, J. P., Maddison, P., Dooley, M. A., van Vollenhoven, R. F., Ginzler, E., Stoll, T., Peschken, C., Jorizzo, J. L., Callen, J. P., Lim, S. S., Fessler, B. J., Inanc, M., Kamen, D. L., Rahman, A., Steinsson, K., Franks, A. G., Sigler, L., Hameed, S., Fang, H., Pham, N., Brey, R., Weisman, M. H., McGwin, G. and Magder, L. S. (2012), Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis & Rheumatism, 64: 2677–2686. doi: 10.1002/art.34473
- Issue published online: 27 JUL 2012
- Article first published online: 27 JUL 2012
- Accepted manuscript online: 2 MAY 2012 03:07PM EST
- Manuscript Accepted: 13 MAR 2012
- Manuscript Received: 29 JUL 2011
- NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases). Grant Number: R01-AR-043727
- Lupus Foundation of America
- Human Genome Sciences (unrestricted research grant)
- NIH. Grant Number: T32-AR-048522
The Systemic Lupus International Collaborating Clinics (SLICC) group revised and validated the American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria in order to improve clinical relevance, meet stringent methodology requirements, and incorporate new knowledge regarding the immunology of SLE.
The classification criteria were derived from a set of 702 expert-rated patient scenarios. Recursive partitioning was used to derive an initial rule that was simplified and refined based on SLICC physician consensus. The SLICC group validated the classification criteria in a new validation sample of 690 new expert-rated patient scenarios.
Seventeen criteria were identified. In the derivation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (49 versus 70; P = 0.0082) and had greater sensitivity (94% versus 86%; P < 0.0001) and equal specificity (92% versus 93%; P = 0.39). In the validation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (62 versus 74; P = 0.24) and had greater sensitivity (97% versus 83%; P < 0.0001) but lower specificity (84% versus 96%; P < 0.0001).
The new SLICC classification criteria performed well in a large set of patient scenarios rated by experts. According to the SLICC rule for the classification of SLE, the patient must satisfy at least 4 criteria, including at least one clinical criterion and one immunologic criterion OR the patient must have biopsy-proven lupus nephritis in the presence of antinuclear antibodies or anti–double-stranded DNA antibodies.