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    Home > Active Ingredient News > Immunology News > Forty years of "suspension tangent": exploring the evolution of systemic lupus erythematosus classification criteria Clinical necessity

    Forty years of "suspension tangent": exploring the evolution of systemic lupus erythematosus classification criteria Clinical necessity

    • Last Update: 2022-10-03
    • Source: Internet
    • Author: User
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    In 1982, the American Society of Rheumatology (ACR) officially issued the classification standard for systemic lupus erythematosus (SLE), which has been 40 years now
    .



    1982 ACR-SLE classification standard and 1997 revision


    In 1971, ACR published the early classification standard of SLE, which contains 14 items, which is the prototype of the subsequent 1982 classification standard and the 1997 revision standard (Table 1)2
    .



    Table 1 SLE classification criteria for 1971-1997


    Meet more than 4 criteria and can be diagnosed
    .



    The 1982 classification criteria listed antinuclear antibody (ANA) testing as a separate diagnostic criterion and lowered the proteinuria criterion from 3.



    In fact, there is controversy
    over whether antiphospholipid antibodies should be included in the 1997 classification criteria.



    2012 SLICC standard


    After 8 years of unremitting efforts, SLE International Clinical Collaboration Group (SLICC) made a new revision on the basis of the 1997 ACR-SLE classification standard, first proposed the new standard at the 2009 ACR Annual Meeting, and published it in 2012 (Table 2).



    Table 2 SLICC classification criteria for 2012


    The SLICC-SLE classification standard has higher sensitivity than the 1997 ACR-SLE standard, but has reduced
    specificity.
    The SLICC-SLE classification criteria eliminates some clinical manifestations with low specificity and sensitivity, but places greater emphasis on organ involvement, greater emphasis on clinical and immunological combinations, and remains simple and easy3
    .


    2019 EUR/ACR-SLE classification standard


    At that time, the classification criteria were better than the diagnostic titer of patients with long-term SLE than those of new-onset patients, so it was imperative to develop a classification standard suitable for early SLE, and the 2019 EULAR/ACR-SLE classification standard came into being
    .
    It not only preserves the specificity of the 1997 SLE classification standard, but also takes into account the sensitivity of the SLICC standard (Figure 1)4
    .


    Figure 1 2019 EULAR/ACR-SLE classification standard


    Both the EULAR and the ACR recommend this standard as the global gold standard and replace the existing other classification standards1
    .
    The 2019 EULAR/ACR-SLE classification standard has the following characteristics compared with the previous standard: (1) The ANA positive is used as the evaluation criterion; (2) Fever is included as a new clinical index; (3) Clinical indicators and immunological indicators are given different weight scores
    .
    There are also shortcomings in this criterion, such as that it is still a classification criterion rather than a diagnostic criterion, so timely and appropriate treatment may also be required for clinical patients who do not meet this criterion4
    .


    Over the past four decades, SLE classification standards have shown organic development rather than a radical breakthrough1
    .
    The manifestations of a small number of patients are gradually included in the classification criteria, such as the SLICC standard cutaneous lupus and alopecia, and the
    fever of the EULER/ACR standard.
    At the same time, more immune parameters were added to the standard, most notably the inclusion of complement levels
    in the SLICC standard.
    As the latest SLE classification standard, the EULER/ACR standard also seems to predict the severity of SLE
    .
    In the future, with the continuous deepening of the concept of precision medicine, genetics, epigenetics, transcriptomics and other technologies may make the academic community have a deeper understanding of the nature of disease occurrence and development, which will help to distinguish more finely between the subtypes of SLE and carry out targeted therapy accordingly, ultimately bringing better prognosis
    to patients.


    References:

    1.
    Aringer M, Costenbader K, Dörner T,et al.
    Advances in SLE classification criteria[J].
    J Autoimmun.
    2022 Jun 17:102845.
    doi: 10.
    1016/j.
    jaut.
    2022.
    102845.
    Epub ahead of print.
    PMID: 35725680.

    2.
    Fu Qiong,Lu Liangjing.
    Development and comparison of classification criteria for systemic lupus erythematosus from 1971 to 2017[J].
    Diagnostics Theory & Practice,2018,17(3):249-253.
    DOI:10.
    16150/j.
    1671-2870.
    2018.
    03.
    004.

    3.
    Jet Shi, Chun Li, Jiaxin Zhu, et al.
    Birth of the latest classification standard for systemic lupus erythematosus[J].
    Chinese Journal of Rheumatology,2012,16(10):713-714.
    DOI:10.
    3760/cma.
    j.
    issn.
    1007-7480.
    2012.
    10.
    017.

    4.
    Li Changhong,Liu Xiangyuan.
    2019 European Union Against Rheumatism / American Society of Rheumatology Systemic Lupus Erythematosus Classification Standard Released[J].
    Chinese Journal of Rheumatology,2019,23(12):862-864.
    DOI:10.
    3760/cma.
    j.
    issn.
    1007-7480.
    2019.
    12.
    016.

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