Performance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities

Sindhu R Johnson; Ralph Brinks; Karen H Costenbader; David Daikh; Marta Mosca; Rosalind Ramsey-Goldman; Josef S Smolen; David Wofsy; Dimitrios T Boumpas; Diane L Kamen; David Jayne; R Cervera; Nathalie Costedoat-Chalumeau; Betty Diamond; Dafna D Gladman; Bevra Hahn; Falk Hiepe; Søren Jacobsen; Dinesh Khanna; Kirsten Lerstrøm; Elena Massarotti; Joseph McCune; Guillermo Ruiz-Irastorza; Jorge Sanchez-Guerrero; Matthias Schneider; Murray Urowitz; George Bertsias; Bimba F Hoyer; Nicolai Leuchten; Chiara Tani; Sara K Tedeschi; Zahi Touma; Gabriela Schmajuk; Branimir Anic; Florence Assan; Tak Mao Chan; Ann Elaine Clarke; Mary K Crow; László Czirják; Andrea Doria; Winfried B Graninger; Bernadett Halda-Kiss; Sarfaraz Hasni; Peter M Izmirly; Michelle Jung; Gábor Kumánovics; Xavier Mariette; Ivan Padjen; José M Pego-Reigosa; Juanita Romero-Diaz; Íñigo Rúa-Figueroa; Raphaèle Seror; Georg H Stummvoll; Yoshiya Tanaka; Maria G Tektonidou; Carlos Vasconcelos; Edward M Vital; D J Wallace; Sule Yavuz; Pier Luigi Meroni; Marvin J Fritzler; Ray Naden; Thomas Dörner; Martin Aringer

doi:10.1136/annrheumdis-2020-217162

Performance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities

Sindhu R Johnson, Ralph Brinks, Karen H Costenbader, David Daikh, Marta Mosca, Rosalind Ramsey-Goldman, Josef S Smolen, David Wofsy, Dimitrios T Boumpas, Diane L Kamen, David Jayne, R Cervera, Nathalie Costedoat-Chalumeau, Betty Diamond, Dafna D Gladman, Bevra Hahn, Falk Hiepe, Søren Jacobsen, Dinesh Khanna, Kirsten LerstrømElena Massarotti, Joseph McCune, Guillermo Ruiz-Irastorza, Jorge Sanchez-Guerrero, Matthias Schneider, Murray Urowitz, George Bertsias, Bimba F Hoyer, Nicolai Leuchten, Chiara Tani, Sara K Tedeschi, Zahi Touma, Gabriela Schmajuk, Branimir Anic, Florence Assan, Tak Mao Chan, Ann Elaine Clarke, Mary K Crow, László Czirják, Andrea Doria, Winfried B Graninger, Bernadett Halda-Kiss, Sarfaraz Hasni, Peter M Izmirly, Michelle Jung, Gábor Kumánovics, Xavier Mariette, Ivan Padjen, José M Pego-Reigosa, Juanita Romero-Diaz, Íñigo Rúa-Figueroa, Raphaèle Seror, Georg H Stummvoll, Yoshiya Tanaka, Maria G Tektonidou, Carlos Vasconcelos, Edward M Vital, D J Wallace, Sule Yavuz, Pier Luigi Meroni, Marvin J Fritzler, Ray Naden, Thomas Dörner, Martin Aringer

Department for Rheumatology and Spine Diseases

48 Citations (Scopus)

Abstract

OBJECTIVES: The European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 Classification Criteria for systemic lupus erythematosus (SLE) have been validated with high sensitivity and specificity. We evaluated the performance of the new criteria with regard to disease duration, sex and race/ethnicity, and compared its performance against the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and ACR 1982/1997 criteria.

METHODS: Twenty-one SLE centres from 16 countries submitted SLE cases and mimicking controls to form the validation cohort. The sensitivity and specificity of the EULAR/ACR 2019, SLICC 2012 and ACR 1982/1997 criteria were evaluated.

RESULTS: The cohort consisted of female (n=1098), male (n=172), Asian (n=118), black (n=68), Hispanic (n=124) and white (n=941) patients; with an SLE duration of 1 to <3 years (n=196) and ≥5 years (n=879). Among patients with 1 to <3 years disease duration, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 81%). The EULAR/ACR criteria performed well in men (sensitivity 93%, specificity 96%) and women (sensitivity 97%, specificity 94%). Among women, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 83%) and better specificity than the SLICC criteria (94% vs 82%). Among white patients, the EULAR/ACR criteria had better sensitivity than the ACR criteria (95% vs 83%) and better specificity than the SLICC criteria (94% vs 83%). The EULAR/ACR criteria performed well among black patients (sensitivity of 98%, specificity 100%), and had better sensitivity than the ACR criteria among Hispanic patients (100% vs 86%) and Asian patients (97% vs 77%).

CONCLUSIONS: The EULAR/ACR 2019 criteria perform well among patients with early disease, men, women, white, black, Hispanic and Asian patients. These criteria have superior sensitivity than the ACR criteria and/or superior specificity than the SLICC criteria across many subgroups.

Original language	English
Journal	Annals of the Rheumatic Diseases
Volume	79
Issue number	10
Pages (from-to)	1333-1339
Number of pages	7
ISSN	0003-4967
DOIs	https://doi.org/10.1136/annrheumdis-2020-217162
Publication status	Published - Oct 2020

Keywords

Female
Humans
Lupus Erythematosus, Systemic/classification
Male
Patient Selection
Sensitivity and Specificity
Severity of Illness Index
epidemiology
systemic lupus erythematosus
lupus nephritis
outcomes research

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Johnson, S. R., Brinks, R., Costenbader, K. H., Daikh, D., Mosca, M., Ramsey-Goldman, R., Smolen, J. S., Wofsy, D., Boumpas, D. T., Kamen, D. L., Jayne, D., Cervera, R., Costedoat-Chalumeau, N., Diamond, B., Gladman, D. D., Hahn, B., Hiepe, F., Jacobsen, S., Khanna, D., ... Aringer, M. (2020). Performance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities. Annals of the Rheumatic Diseases, 79(10), 1333-1339. https://doi.org/10.1136/annrheumdis-2020-217162

Johnson, SR, Brinks, R, Costenbader, KH, Daikh, D, Mosca, M, Ramsey-Goldman, R, Smolen, JS, Wofsy, D, Boumpas, DT, Kamen, DL, Jayne, D, Cervera, R, Costedoat-Chalumeau, N, Diamond, B, Gladman, DD, Hahn, B, Hiepe, F, Jacobsen, S, Khanna, D, Lerstrøm, K, Massarotti, E, McCune, J, Ruiz-Irastorza, G, Sanchez-Guerrero, J, Schneider, M, Urowitz, M, Bertsias, G, Hoyer, BF, Leuchten, N, Tani, C, Tedeschi, SK, Touma, Z, Schmajuk, G, Anic, B, Assan, F, Chan, TM, Clarke, AE, Crow, MK, Czirják, L, Doria, A, Graninger, WB, Halda-Kiss, B, Hasni, S, Izmirly, PM, Jung, M, Kumánovics, G, Mariette, X, Padjen, I, Pego-Reigosa, JM, Romero-Diaz, J, Rúa-Figueroa, Í, Seror, R, Stummvoll, GH, Tanaka, Y, Tektonidou, MG, Vasconcelos, C, Vital, EM, Wallace, DJ, Yavuz, S, Meroni, PL, Fritzler, MJ, Naden, R, Dörner, T & Aringer, M 2020, 'Performance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities', Annals of the Rheumatic Diseases, vol. 79, no. 10, pp. 1333-1339. https://doi.org/10.1136/annrheumdis-2020-217162

@article{a4998b6e65ae4bcb8328f91089f5b5f9,

title = "Performance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities",

abstract = "OBJECTIVES: The European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 Classification Criteria for systemic lupus erythematosus (SLE) have been validated with high sensitivity and specificity. We evaluated the performance of the new criteria with regard to disease duration, sex and race/ethnicity, and compared its performance against the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and ACR 1982/1997 criteria.METHODS: Twenty-one SLE centres from 16 countries submitted SLE cases and mimicking controls to form the validation cohort. The sensitivity and specificity of the EULAR/ACR 2019, SLICC 2012 and ACR 1982/1997 criteria were evaluated.RESULTS: The cohort consisted of female (n=1098), male (n=172), Asian (n=118), black (n=68), Hispanic (n=124) and white (n=941) patients; with an SLE duration of 1 to <3 years (n=196) and ≥5 years (n=879). Among patients with 1 to <3 years disease duration, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 81%). The EULAR/ACR criteria performed well in men (sensitivity 93%, specificity 96%) and women (sensitivity 97%, specificity 94%). Among women, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 83%) and better specificity than the SLICC criteria (94% vs 82%). Among white patients, the EULAR/ACR criteria had better sensitivity than the ACR criteria (95% vs 83%) and better specificity than the SLICC criteria (94% vs 83%). The EULAR/ACR criteria performed well among black patients (sensitivity of 98%, specificity 100%), and had better sensitivity than the ACR criteria among Hispanic patients (100% vs 86%) and Asian patients (97% vs 77%).CONCLUSIONS: The EULAR/ACR 2019 criteria perform well among patients with early disease, men, women, white, black, Hispanic and Asian patients. These criteria have superior sensitivity than the ACR criteria and/or superior specificity than the SLICC criteria across many subgroups.",

keywords = "Female, Humans, Lupus Erythematosus, Systemic/classification, Male, Patient Selection, Sensitivity and Specificity, Severity of Illness Index, epidemiology, systemic lupus erythematosus, lupus nephritis, outcomes research",

author = "Johnson, {Sindhu R} and Ralph Brinks and Costenbader, {Karen H} and David Daikh and Marta Mosca and Rosalind Ramsey-Goldman and Smolen, {Josef S} and David Wofsy and Boumpas, {Dimitrios T} and Kamen, {Diane L} and David Jayne and R Cervera and Nathalie Costedoat-Chalumeau and Betty Diamond and Gladman, {Dafna D} and Bevra Hahn and Falk Hiepe and S{\o}ren Jacobsen and Dinesh Khanna and Kirsten Lerstr{\o}m and Elena Massarotti and Joseph McCune and Guillermo Ruiz-Irastorza and Jorge Sanchez-Guerrero and Matthias Schneider and Murray Urowitz and George Bertsias and Hoyer, {Bimba F} and Nicolai Leuchten and Chiara Tani and Tedeschi, {Sara K} and Zahi Touma and Gabriela Schmajuk and Branimir Anic and Florence Assan and Chan, {Tak Mao} and Clarke, {Ann Elaine} and Crow, {Mary K} and L{\'a}szl{\'o} Czirj{\'a}k and Andrea Doria and Graninger, {Winfried B} and Bernadett Halda-Kiss and Sarfaraz Hasni and Izmirly, {Peter M} and Michelle Jung and G{\'a}bor Kum{\'a}novics and Xavier Mariette and Ivan Padjen and Pego-Reigosa, {Jos{\'e} M} and Juanita Romero-Diaz and {\'I}{\~n}igo R{\'u}a-Figueroa and Rapha{\`e}le Seror and Stummvoll, {Georg H} and Yoshiya Tanaka and Tektonidou, {Maria G} and Carlos Vasconcelos and Vital, {Edward M} and Wallace, {D J} and Sule Yavuz and Meroni, {Pier Luigi} and Fritzler, {Marvin J} and Ray Naden and Thomas D{\"o}rner and Martin Aringer",

note = "{\textcopyright} Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2020",

month = oct,

doi = "10.1136/annrheumdis-2020-217162",

language = "English",

volume = "79",

pages = "1333--1339",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "B M J Group",

number = "10",

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TY - JOUR

T1 - Performance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities

AU - Johnson, Sindhu R

AU - Brinks, Ralph

AU - Costenbader, Karen H

AU - Daikh, David

AU - Mosca, Marta

AU - Ramsey-Goldman, Rosalind

AU - Smolen, Josef S

AU - Wofsy, David

AU - Boumpas, Dimitrios T

AU - Kamen, Diane L

AU - Jayne, David

AU - Cervera, R

AU - Costedoat-Chalumeau, Nathalie

AU - Diamond, Betty

AU - Gladman, Dafna D

AU - Hahn, Bevra

AU - Hiepe, Falk

AU - Jacobsen, Søren

AU - Khanna, Dinesh

AU - Lerstrøm, Kirsten

AU - Massarotti, Elena

AU - McCune, Joseph

AU - Ruiz-Irastorza, Guillermo

AU - Sanchez-Guerrero, Jorge

AU - Schneider, Matthias

AU - Urowitz, Murray

AU - Bertsias, George

AU - Hoyer, Bimba F

AU - Leuchten, Nicolai

AU - Tani, Chiara

AU - Tedeschi, Sara K

AU - Touma, Zahi

AU - Schmajuk, Gabriela

AU - Anic, Branimir

AU - Assan, Florence

AU - Chan, Tak Mao

AU - Clarke, Ann Elaine

AU - Crow, Mary K

AU - Czirják, László

AU - Doria, Andrea

AU - Graninger, Winfried B

AU - Halda-Kiss, Bernadett

AU - Hasni, Sarfaraz

AU - Izmirly, Peter M

AU - Jung, Michelle

AU - Kumánovics, Gábor

AU - Mariette, Xavier

AU - Padjen, Ivan

AU - Pego-Reigosa, José M

AU - Romero-Diaz, Juanita

AU - Rúa-Figueroa, Íñigo

AU - Seror, Raphaèle

AU - Stummvoll, Georg H

AU - Tanaka, Yoshiya

AU - Tektonidou, Maria G

AU - Vasconcelos, Carlos

AU - Vital, Edward M

AU - Wallace, D J

AU - Yavuz, Sule

AU - Meroni, Pier Luigi

AU - Fritzler, Marvin J

AU - Naden, Ray

AU - Dörner, Thomas

AU - Aringer, Martin

PY - 2020/10

Y1 - 2020/10

N2 - OBJECTIVES: The European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 Classification Criteria for systemic lupus erythematosus (SLE) have been validated with high sensitivity and specificity. We evaluated the performance of the new criteria with regard to disease duration, sex and race/ethnicity, and compared its performance against the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and ACR 1982/1997 criteria.METHODS: Twenty-one SLE centres from 16 countries submitted SLE cases and mimicking controls to form the validation cohort. The sensitivity and specificity of the EULAR/ACR 2019, SLICC 2012 and ACR 1982/1997 criteria were evaluated.RESULTS: The cohort consisted of female (n=1098), male (n=172), Asian (n=118), black (n=68), Hispanic (n=124) and white (n=941) patients; with an SLE duration of 1 to <3 years (n=196) and ≥5 years (n=879). Among patients with 1 to <3 years disease duration, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 81%). The EULAR/ACR criteria performed well in men (sensitivity 93%, specificity 96%) and women (sensitivity 97%, specificity 94%). Among women, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 83%) and better specificity than the SLICC criteria (94% vs 82%). Among white patients, the EULAR/ACR criteria had better sensitivity than the ACR criteria (95% vs 83%) and better specificity than the SLICC criteria (94% vs 83%). The EULAR/ACR criteria performed well among black patients (sensitivity of 98%, specificity 100%), and had better sensitivity than the ACR criteria among Hispanic patients (100% vs 86%) and Asian patients (97% vs 77%).CONCLUSIONS: The EULAR/ACR 2019 criteria perform well among patients with early disease, men, women, white, black, Hispanic and Asian patients. These criteria have superior sensitivity than the ACR criteria and/or superior specificity than the SLICC criteria across many subgroups.

AB - OBJECTIVES: The European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 Classification Criteria for systemic lupus erythematosus (SLE) have been validated with high sensitivity and specificity. We evaluated the performance of the new criteria with regard to disease duration, sex and race/ethnicity, and compared its performance against the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and ACR 1982/1997 criteria.METHODS: Twenty-one SLE centres from 16 countries submitted SLE cases and mimicking controls to form the validation cohort. The sensitivity and specificity of the EULAR/ACR 2019, SLICC 2012 and ACR 1982/1997 criteria were evaluated.RESULTS: The cohort consisted of female (n=1098), male (n=172), Asian (n=118), black (n=68), Hispanic (n=124) and white (n=941) patients; with an SLE duration of 1 to <3 years (n=196) and ≥5 years (n=879). Among patients with 1 to <3 years disease duration, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 81%). The EULAR/ACR criteria performed well in men (sensitivity 93%, specificity 96%) and women (sensitivity 97%, specificity 94%). Among women, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 83%) and better specificity than the SLICC criteria (94% vs 82%). Among white patients, the EULAR/ACR criteria had better sensitivity than the ACR criteria (95% vs 83%) and better specificity than the SLICC criteria (94% vs 83%). The EULAR/ACR criteria performed well among black patients (sensitivity of 98%, specificity 100%), and had better sensitivity than the ACR criteria among Hispanic patients (100% vs 86%) and Asian patients (97% vs 77%).CONCLUSIONS: The EULAR/ACR 2019 criteria perform well among patients with early disease, men, women, white, black, Hispanic and Asian patients. These criteria have superior sensitivity than the ACR criteria and/or superior specificity than the SLICC criteria across many subgroups.

KW - Female

KW - Humans

KW - Lupus Erythematosus, Systemic/classification

KW - Male

KW - Patient Selection

KW - Sensitivity and Specificity

KW - Severity of Illness Index

KW - epidemiology

KW - systemic lupus erythematosus

KW - lupus nephritis

KW - outcomes research

UR - http://www.scopus.com/inward/record.url?scp=85090003541&partnerID=8YFLogxK

U2 - 10.1136/annrheumdis-2020-217162

DO - 10.1136/annrheumdis-2020-217162

M3 - Journal article

C2 - 32816709

SN - 0003-4967

VL - 79

SP - 1333

EP - 1339

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 10

ER -

Performance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities

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