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Juvenile systemic lupus erythematosus (jSLE) patients refer to SLE patients whose age of onset is less than 18 years old.
As there is no diagnostic criteria for jSLE at this time, the adult diagnostic criteria are mostly used as the basis for diagnosis of such patients in clinical practice.
Is renal involvement in jSLE patients consistent with adult diagnostic criteria? The SLE classification standard (EULAR/ACR-19 standard) established by the European Union of Rheumatology and the American College of Rheumatology in 2019 is the latest standard for the diagnosis of adult SLE.
And the total score ≥ 10 points, can be diagnosed as SLE.
However, jSLE and adult SLE are different in many aspects such as clinical manifestations, so does this standard apply to adolescents? A retrospective multi-center study conducted by Israeli scholar Levinsky et al.
showed that the EULAR/ACR-19 standard is applicable to jSLE patients.
The research results were recently published in the journal Rheumatology (Oxford).
(Impact factor 5.
606).
Study Design The study included 225 patients: 112 jSLE patients; 113 non-jSLE patients with similar symptoms to jSLE.
Rheumatologists diagnose all cases without knowing the original diagnosis and treatment process.
The study extracts the clinical and laboratory data of patients to verify whether the patients meet the following diagnostic criteria: EULAR/ACR-19 standard, SLE classification standard (SLICC-12 standard) established by the International Lupus Research Clinical Collaboration Group in 2012 and ACR established in 1997 SLE classification standard (ACR-97 standard).
The sensitivity and specificity of the results of the study When diagnosing jSLE, the sensitivity of the EULAR/ACR-19 standard was 0.
96 (95% CI: 0.
9-0.
99), which was the same as the SLICC-12 standard and higher than the ACR-97 standard (0.
79); The specificity of EULAR/ACR-19 standard is 0.
89 (95%CI: 0.
82-0.
94), which is higher than SLICC-12 standard (0.
85) and lower than ACR-97 standard (0.
94).
Analyze the sensitivity and specificity of the three standards over time.
From the data of 12 months, 1 to 2 years and more than 2 years after the onset, it can be seen that the sensitivity of the EULAR/ACR-19 standard changes over time.
Improved, and the sensitivity for patients with a course of disease> 2 years reached 0.
96.
In addition, the sensitivity of EULAR/ACR-19 and SLICC-12 standards were significantly better than that of ACR-97 standards (all p values <0.
001); the three standards had no significant differences in specificity.
The diagnostic effect study showed that the area under the curve of the EULAR/ACR-19 standard was 0.
93 (95% CI: 0.
89-0.
96), which was higher than the other two standards.
At the same time, the EULAR/ACR-19 standard is significantly better than the ACR-1997 standard (p=0.
017).
The results of subgroup analysis divided patients into different subgroups based on clinical symptoms and gender, and tested whether each group of patients meets EULAR/ACR-19 standards.
The data shows that EULAR/ACR-19 standards are highly sensitive in each subgroup.
(Table 1).
Table 1 The performance of EULAR/ACR-19 standard in each subgroup of patients.
Compared with the previous standard, EULAR/ACR-19 standard increases antinuclear antibody (ANA) positive as a necessary condition.
Some clinicians worry that this may lead to Missed diagnosis of ANA-negative patients.
However, research data shows that in jSLE patients, the sensitivity and specificity of the EULAR/ACR-19 standard is not lower than that of the SLICC-12 standard.
In summary, in the study's jSLE patient cohort, the EULAR/ACR-19 criterion had a sensitivity of 0.
96 and a specificity of 0.
89.
The results suggest that the EULAR/ACR-19 standard can be used for the diagnosis of juvenile SLE patients.
However, it should be noted that its specificity in adolescents is still lower than that of adults (0.
93).
Recently, Nat Rev Rheumatol.
(Impact Factor IF: 16.
625), an authoritative journal in the field of rheumatism, also released a comment based on the results of this study: EULAR/ACR-19 standards apply to adolescent SLE patients.
But to be cautious, I hope that future studies with large sample sizes and multi-ethnic populations will verify this conclusion.
Only by determining the classification of SLE, can we evaluate the degree of renal involvement and better guide nephrologists to intervene in the treatment of SLE.
References: 1.
Levinsky Y, Broide M, Kagan S, et al.
Performance of 2019 EULAR/ACR classification criteria for Systemic Lupus Erythematosus in a pediatric population-a multicenter study[J].
Rheumatology (Oxford).
2021 Feb 9: keab140.
2.
McHugh J.
2019 EULAR-ACR classification criteria for SLE performs well in children.
Nat Rev Rheumatol.
2021 Apr;17(4):188.
As there is no diagnostic criteria for jSLE at this time, the adult diagnostic criteria are mostly used as the basis for diagnosis of such patients in clinical practice.
Is renal involvement in jSLE patients consistent with adult diagnostic criteria? The SLE classification standard (EULAR/ACR-19 standard) established by the European Union of Rheumatology and the American College of Rheumatology in 2019 is the latest standard for the diagnosis of adult SLE.
And the total score ≥ 10 points, can be diagnosed as SLE.
However, jSLE and adult SLE are different in many aspects such as clinical manifestations, so does this standard apply to adolescents? A retrospective multi-center study conducted by Israeli scholar Levinsky et al.
showed that the EULAR/ACR-19 standard is applicable to jSLE patients.
The research results were recently published in the journal Rheumatology (Oxford).
(Impact factor 5.
606).
Study Design The study included 225 patients: 112 jSLE patients; 113 non-jSLE patients with similar symptoms to jSLE.
Rheumatologists diagnose all cases without knowing the original diagnosis and treatment process.
The study extracts the clinical and laboratory data of patients to verify whether the patients meet the following diagnostic criteria: EULAR/ACR-19 standard, SLE classification standard (SLICC-12 standard) established by the International Lupus Research Clinical Collaboration Group in 2012 and ACR established in 1997 SLE classification standard (ACR-97 standard).
The sensitivity and specificity of the results of the study When diagnosing jSLE, the sensitivity of the EULAR/ACR-19 standard was 0.
96 (95% CI: 0.
9-0.
99), which was the same as the SLICC-12 standard and higher than the ACR-97 standard (0.
79); The specificity of EULAR/ACR-19 standard is 0.
89 (95%CI: 0.
82-0.
94), which is higher than SLICC-12 standard (0.
85) and lower than ACR-97 standard (0.
94).
Analyze the sensitivity and specificity of the three standards over time.
From the data of 12 months, 1 to 2 years and more than 2 years after the onset, it can be seen that the sensitivity of the EULAR/ACR-19 standard changes over time.
Improved, and the sensitivity for patients with a course of disease> 2 years reached 0.
96.
In addition, the sensitivity of EULAR/ACR-19 and SLICC-12 standards were significantly better than that of ACR-97 standards (all p values <0.
001); the three standards had no significant differences in specificity.
The diagnostic effect study showed that the area under the curve of the EULAR/ACR-19 standard was 0.
93 (95% CI: 0.
89-0.
96), which was higher than the other two standards.
At the same time, the EULAR/ACR-19 standard is significantly better than the ACR-1997 standard (p=0.
017).
The results of subgroup analysis divided patients into different subgroups based on clinical symptoms and gender, and tested whether each group of patients meets EULAR/ACR-19 standards.
The data shows that EULAR/ACR-19 standards are highly sensitive in each subgroup.
(Table 1).
Table 1 The performance of EULAR/ACR-19 standard in each subgroup of patients.
Compared with the previous standard, EULAR/ACR-19 standard increases antinuclear antibody (ANA) positive as a necessary condition.
Some clinicians worry that this may lead to Missed diagnosis of ANA-negative patients.
However, research data shows that in jSLE patients, the sensitivity and specificity of the EULAR/ACR-19 standard is not lower than that of the SLICC-12 standard.
In summary, in the study's jSLE patient cohort, the EULAR/ACR-19 criterion had a sensitivity of 0.
96 and a specificity of 0.
89.
The results suggest that the EULAR/ACR-19 standard can be used for the diagnosis of juvenile SLE patients.
However, it should be noted that its specificity in adolescents is still lower than that of adults (0.
93).
Recently, Nat Rev Rheumatol.
(Impact Factor IF: 16.
625), an authoritative journal in the field of rheumatism, also released a comment based on the results of this study: EULAR/ACR-19 standards apply to adolescent SLE patients.
But to be cautious, I hope that future studies with large sample sizes and multi-ethnic populations will verify this conclusion.
Only by determining the classification of SLE, can we evaluate the degree of renal involvement and better guide nephrologists to intervene in the treatment of SLE.
References: 1.
Levinsky Y, Broide M, Kagan S, et al.
Performance of 2019 EULAR/ACR classification criteria for Systemic Lupus Erythematosus in a pediatric population-a multicenter study[J].
Rheumatology (Oxford).
2021 Feb 9: keab140.
2.
McHugh J.
2019 EULAR-ACR classification criteria for SLE performs well in children.
Nat Rev Rheumatol.
2021 Apr;17(4):188.
