January 16, 2018
2 min read

ACR/EULAR identify 40 candidate criteria for SLE classification

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Gabriela Schmajuk

The first phase of drafting new classification criteria for systemic lupus erythematosus, undertaken by the American College of Rheumatology and EULAR, produced 40 candidate criteria for subsequent assessment, according to findings recently published in Arthritis Care and Research.

“This study describes the first phase of the joint EULAR-ACR [systemic lupus erythematosus (SLE)] classification criteria project,” Gabriela Schmajuk, MD, MS, of the University of California, San Francisco, and the San Francisco VA Medical Center, told Healio Rheumatology. “It represents a huge international effort to generate new candidate items for the SLE classification criteria project, from more than a hundred SLE experts from around the world, using a Delphi methodology.”

Sindhu Johnson, MD, PhD, director of the Toronto Scleroderma Program at the University of Toronto, and co-chair of the 12-member steering committee that developed the new criteria, said in a November press conference that the ACR and EULAR had partnered 4 years ago to devise a classification system that reflects the current understanding of SLE, and that could be readily used by the global rheumatology community.

The entire effort included a four-phase drafting process, with input from experts and data from more than 2,200 patients and 150 investigators from both organizations, she said. The two groups released a draft of their classification criteria in November 2017 at the ACR Annual Meeting. Final validation of the criteria is expected to be presented at the EULAR Annual Meeting in June, following a revision process.

In the recently published first phase, Schmajuk, Johnson and colleagues developed a comprehensive list of candidate criteria to be considered for the classification of the disease, and then worked to reduce that list to a more manageable number. The researchers recruited an international group of experts to participate, including 135 invitees for the initial item generation, and 147 for the later reduction process.

The experts were given an online survey and asked to generate, rate and select prospective classification criteria, based on their importance in diagnosing early and established SLE.

According to the researchers, the first group of experts developed an initial list of 145 classification criteria for the disease. The second group then condensed that list to 40 criteria, which would then be used in the second phase of the drafting process, and later reduced to 10 “domains.” Among the 40 criteria, those than garnered a 100% rating included anti-double stranded DNA antibody; acute, subacute or chronic lupus rash; and low C3 and C4 biomarkers.


In assessing the 40 criteria, the researchers found that 51% of the members determined that although a single organ system would be sufficient for classifying SLE, additional typical laboratory features would be required. The researchers also noted that 85% of the recruited experts would positively classify the disease when renal pathology alone demonstrated lupus nephritis.

“The number and breadth of expertise of the participants makes this item generation phase unique from prior efforts, and makes this list of candidate items a truly representative view of a modern approach to SLE classification,” Schmajuk said. “The outcome of this process was to generate 40 candidate items that were subsequently reduced and grouped into 10 domains and the final, new classification criteria were announced at the ACR [2017 Annual Meeting].” – by Jason Laday

Disclosure: Schmajuk reports funding from the NIH and the Russell/Engleman Medical Research Center for Arthritis. The researchers also report support from the ACR and EULAR.