Evaluating the performance of ACR, SLICC and EULAR/ACR classification criteria in childhood onset systemic lupus erythematosus.
Journal
Pediatric rheumatology online journal
ISSN: 1546-0096
Titre abrégé: Pediatr Rheumatol Online J
Pays: England
ID NLM: 101248897
Informations de publication
Date de publication:
09 Sep 2021
09 Sep 2021
Historique:
received:
08
03
2021
accepted:
24
06
2021
entrez:
10
9
2021
pubmed:
11
9
2021
medline:
11
2
2022
Statut:
epublish
Résumé
The ACR 1997, SLICC 2012 and EULAR/ACR 2019 classification criteria were validated based on adult patients. To date, there are no classification criteria specific for children with SLE. The aim of the study is to compare the performance characteristics among the three SLE classification criteria (ACR-1997, SLICC-2012 and EULAR/ACR-2019) in childhood onset SLE (cSLE) cohort of Arab ethnicity from Oman. We conducted a retrospective multicenter study in Oman of cSLE patients as cases and patients with other rheumatic disease with a positive ANA titer as controls. The cSLE cases recruited were children diagnosed with SLE before 13 years of age. Data was retrospectively collected to establish the ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria fulfilled at first visit, first year follow up and last follow up. Study population included 113 cSLE cases (mean age at diagnosis of 7.3 ± 3.4 years with disease duration of 6.1 ± 4.6 years) and 51 controls (mean age at diagnosis 5.0 ± 3.4 with disease duration 5.7 ± 3.9). The cSLE cases had higher frequency of familial SLE than controls (38% vs 7.8%; p < 0.001). The performance measures demonstrated that EULAR/ACR-2019 criteria had the highest sensitivity (81, 88, 89%) compared to ACR 1997 (49, 57, 66%) and SLICC 2012 (76, 84,86%); while the ACR 1997 had the highest specificity (96%) compared to SLICC 2012 (94%) and EULAR/ACR 2019 (90%) at first visit, first year and last assessment. When we increased the threshold score to ≥13 rather than the traditional score ≥ 10 for ACR/EULAR 2019, there was increased specificity (96%) at the expense of lower sensitivity (76, 83, and 84%) at first visit, first year and last assessment. In this cSLE population, EULAR/ACR 2019 scored better at initial presentation, first year and last assessment follow up. Further multinational studies are needed to validate the appropriate cut off score for the newly proposed ACR/EULAR 2019 classification criteria in cSLE to increase early sensitivity and specificity for cSLE classification.
Sections du résumé
BACKGROUND
BACKGROUND
The ACR 1997, SLICC 2012 and EULAR/ACR 2019 classification criteria were validated based on adult patients. To date, there are no classification criteria specific for children with SLE. The aim of the study is to compare the performance characteristics among the three SLE classification criteria (ACR-1997, SLICC-2012 and EULAR/ACR-2019) in childhood onset SLE (cSLE) cohort of Arab ethnicity from Oman.
METHODS
METHODS
We conducted a retrospective multicenter study in Oman of cSLE patients as cases and patients with other rheumatic disease with a positive ANA titer as controls. The cSLE cases recruited were children diagnosed with SLE before 13 years of age. Data was retrospectively collected to establish the ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria fulfilled at first visit, first year follow up and last follow up.
RESULTS
RESULTS
Study population included 113 cSLE cases (mean age at diagnosis of 7.3 ± 3.4 years with disease duration of 6.1 ± 4.6 years) and 51 controls (mean age at diagnosis 5.0 ± 3.4 with disease duration 5.7 ± 3.9). The cSLE cases had higher frequency of familial SLE than controls (38% vs 7.8%; p < 0.001). The performance measures demonstrated that EULAR/ACR-2019 criteria had the highest sensitivity (81, 88, 89%) compared to ACR 1997 (49, 57, 66%) and SLICC 2012 (76, 84,86%); while the ACR 1997 had the highest specificity (96%) compared to SLICC 2012 (94%) and EULAR/ACR 2019 (90%) at first visit, first year and last assessment. When we increased the threshold score to ≥13 rather than the traditional score ≥ 10 for ACR/EULAR 2019, there was increased specificity (96%) at the expense of lower sensitivity (76, 83, and 84%) at first visit, first year and last assessment.
CONCLUSION
CONCLUSIONS
In this cSLE population, EULAR/ACR 2019 scored better at initial presentation, first year and last assessment follow up. Further multinational studies are needed to validate the appropriate cut off score for the newly proposed ACR/EULAR 2019 classification criteria in cSLE to increase early sensitivity and specificity for cSLE classification.
Identifiants
pubmed: 34503539
doi: 10.1186/s12969-021-00619-w
pii: 10.1186/s12969-021-00619-w
pmc: PMC8428110
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
141Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2021. The Author(s).
Références
Tarr T, Dérfalvi B, Győri N, Szántó A, Siminszky Z, Malik A, et al. Similarities and differences between pediatric and adult patients with systemic lupus erythematosus. Lupus. 2015;24(8):796–803. https://doi.org/10.1177/0961203314563817 .
doi: 10.1177/0961203314563817
pubmed: 25516474
Fonseca R, Aguiar F, Rodrigues M, Brito I. Clinical phenotype and outcome in lupus according to age: a comparison between juvenile and adult onset. Reumatol Clin. 2018;14(3):160–3. https://doi.org/10.1016/j.reuma.2016.10.011 .
doi: 10.1016/j.reuma.2016.10.011
pubmed: 28040420
Al Rasbi A, Abdalla E, Sultan R, Abdullah N, Al Kaabi J, Al-Zakwani I, et al. Spectrum of systemic lupus erythematosus in Oman: from childhood to adulthood. Rheumatol Int. 2018;38(9):1691–8. https://doi.org/10.1007/s00296-018-4032-2 .
doi: 10.1007/s00296-018-4032-2
pubmed: 29721697
Bertsias GK, Pamfil C, Fanouriakis A, Boumpas DT. Diagnostic criteria for systemic lupus erythematosus: has the time come? Nat Rev Rheumatol. 2013;9(11):687–94. https://doi.org/10.1038/nrrheum.2013.103 .
doi: 10.1038/nrrheum.2013.103
pubmed: 23838616
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725. https://doi.org/10.1002/art.1780400928 .
doi: 10.1002/art.1780400928
pubmed: 9324032
pmcid: 9324032
Smith EL, Shmerling RH. The American College of Rheumatology criteria for the classification of systemic lupus erythematosus: strengths, weaknesses, and opportunities for improvement. Lupus. 1999;8(8):586–95. https://doi.org/10.1191/096120399680411317 .
doi: 10.1191/096120399680411317
pubmed: 10568894
Petri M, Magder L. Classification criteria for systemic lupus erythematosus: a review. Lupus. 2004;13(11):829–37. https://doi.org/10.1191/0961203304lu2019oa .
doi: 10.1191/0961203304lu2019oa
pubmed: 15580978
Petri M. Review of classification criteria for systemic lupus erythematosus. Rheum Dis Clin N Am. 2005;31(2):245–54. https://doi.org/10.1016/j.rdc.2005.01.009 .
doi: 10.1016/j.rdc.2005.01.009
Tedeschi SK, Johnson SR, Boumpas D, Daikh D, Dörner T, Jayne D, et al. Developing and refining new candidate criteria for systemic lupus erythematosus classification: an international collaboration. Arthritis Care Res (Hoboken). 2018;70(4):571–81. https://doi.org/10.1002/acr.23317 .
doi: 10.1002/acr.23317
Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64(8):2677–86. https://doi.org/10.1002/art.34473 .
doi: 10.1002/art.34473
pubmed: 22553077
pmcid: 3409311
Tedeschi SK, Johnson SR, Boumpas DT, Daikh D, Dörner T, Diamond B, et al. Multicriteria decision analysis process to develop new classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019;78(5):634–40. https://doi.org/10.1136/annrheumdis-2018-214685 .
doi: 10.1136/annrheumdis-2018-214685
pubmed: 30692164
Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019;78(9):1151–9. https://doi.org/10.1136/annrheumdis-2018-214819 .
doi: 10.1136/annrheumdis-2018-214819
pubmed: 31383717
Sag E, Tartaglione A, Batu ED, Ravelli A, Khalil SM, Marks SD, et al. Performance of the new SLICC classification criteria in childhood systemic lupus erythematosus: a multicentre study. Clin Exp Rheumatol. 2014;32(3):440–4.
pubmed: 24642380
Fonseca AR, Gaspar-Elsas MI, Land MG, de Oliveira SK. Comparison between three systems of classification criteria in juvenile systemic lupus erythematous. Rheumatology (Oxford). 2015;54(2):241–7. https://doi.org/10.1093/rheumatology/keu278 .
doi: 10.1093/rheumatology/keu278
Lythgoe H, Morgan T, Heaf E, Lloyd O, Al-Abadi E, Armon K, et al. UK JSLE study group. Evaluation of the ACR and SLICC classification criteria in juvenile-onset systemic lupus erythematosus: a longitudinal analysis. Lupus. 2017;26(12):1285–90. https://doi.org/10.1177/0961203317700484 .
doi: 10.1177/0961203317700484
pubmed: 28361566
Rodrigues Fonseca A, Felix Rodrigues MC, Sztajnbok FR, Gerardin Poirot Land M, Knupp Feitosa de Oliveira S. Comparison among ACR1997, SLICC and the new EULAR/ACR classification criteria in childhood-onset systemic lupus erythematosus. Adv Rheumatol. 2019;59(1):20.
doi: 10.1186/s42358-019-0062-z
Tao JJ, Hiraki LT, Levy DM, Silverman ED. Comparison of sensitivities of American College of Rheumatology and Systemic Lupus International Collaborating Clinics Classification Criteria in childhood-onset systemic lupus erythematosus. J Rheumatol. 2019;46(7):731–8. https://doi.org/10.3899/jrheum.180337 .
doi: 10.3899/jrheum.180337
pubmed: 30770510
Batu ED, Akca UK, Kısaarslan AP, Sağ E, Demir F, Demir S, et al. The Performances of the ACR 1997, SLICC 2012, and EULAR/ACR 2019 Classification Criteria in Pediatric Systemic Lupus Erythematosus. J Rheumatol. 2021;48(6):907–14.
doi: 10.3899/jrheum.200871
Levinsky Y, Broide M, Kagan S, Goldberg O, Scheuerman O, et al. Performance of 2019 EULAR/ACR classification criteria for Systemic Lupus Erythematosus in a pediatric population - a multicenter study. Rheumatology (Oxford). 2021:keab140. https://doi.org/10.1093/rheumatology/keab140 .
González LA, Toloza SM, McGwin G Jr, Alarcón GS. Ethnicity in systemic lupus erythematosus (SLE): its influence on susceptibility and outcomes. Lupus. 2013;22(12):1214–24. https://doi.org/10.1177/0961203313502571 .
doi: 10.1177/0961203313502571
pubmed: 24097993
Bundhund PK, Kumari A, Huang F. Differences in clinical features observed between childhood-onset versus adult-onset systemic lupus erythematosus: a systematic review and meta-analysis. Medicine (Baltimore). 2017;96(37):e8086. https://doi.org/10.1097/MD.0000000000008086 .
doi: 10.1097/MD.0000000000008086
Arnett FC, Shulman LE. Studies in familial systemic lupus erythematosus. Medicine (Baltimore). 1976;55(4):313–22. https://doi.org/10.1097/00005792-197607000-00003 .
doi: 10.1097/00005792-197607000-00003
Abdwani R, Hira M, Al-Nabhani D, Al-Zakwani I. Juvenile systemic lupus erythematosus in the Sultanate of Oman: clinical and immunological comparison between familial and non-familial cases. Lupus. 2011;20(3):315–9. https://doi.org/10.1177/0961203310383299 .
doi: 10.1177/0961203310383299
pubmed: 21183560
Nair HB, Balan S. Validation of 2019 EULAR/ACR classification criteria for SLE in South Indian Juvenile SLE cohort. P140. Rheumatology. 2020;59(Supplement_2):keaa111.13.
Lewis MJ, Jawad AS. The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematosus. Rheumatology (Oxford). 2017;56(suppl_1):i67–77.
Al-Mayouf S, Sunker A, Abdwani R, Abrawi SA, Almurshedi F, Alhashmi N, et al. Loss-of-function variant in DNASE1L3 causes a familial form of systemic lupus erythematosus. Nat Genet. 2011;43(12):1186–8. https://doi.org/10.1038/ng.975 .
doi: 10.1038/ng.975
pubmed: 22019780
Al-Mayouf SM, Abdwani R, Al-Brawi S. Familial juvenile systemic lupus erythematosus in Arab children. Rheumatol Int. 2012;32(7):1939–43. https://doi.org/10.1007/s00296-011-1886-y .
doi: 10.1007/s00296-011-1886-y
pubmed: 21461717
Hartman EAR, van Royen-Kerkhof A, Jacobs JWG, Welsing PMJ, Fritsch-Stork RDE. Performance of the 2012 systemic lupus international collaborating clinics classification criteria versus the 1997 American College of Rheumatology classification criteria in adult and juvenile systemic lupus erythematosus. A systematic review and meta-analysis. Autoimmun Rev. 2018;17(3):316–22. https://doi.org/10.1016/j.autrev.2018.01.007 .
doi: 10.1016/j.autrev.2018.01.007
pubmed: 29366725