Patients who fail to meet 2019 EULAR/ACR lupus criteria amass less damage
Among participants of a multiethnic lupus cohort recruited using the 1982/1997 American College of Rheumatology criteria, those who failed to achieve the new 2019 EULAR/ACR criteria accrued less damage than those who did, according to data published in Arthritis Care & Research.
“This is the first study to report the impact of achieving — or not — the EULAR/ACR criteria on damage accrual,” Manuel F. Ugarte-Gil, MD, MSc, of the Guillermo Almenara Irigoyen National Hospital, in Lima, Peru, told Healio Rheumatology. “Several groups have evaluated whether these criteria were more sensitive than the previous one or not. However, it is also important to know if those patients classified with these criteria will have the same prognosis as those who will not.”
To examine the differences in outcomes among patients who achieved the 2019 EULAR/ACR SLE criteria and those who did not, Ugarte-Gil and colleagues studied data from the U.S. LUMINA (Lupus in Minorities: Nature vs nurture) cohort. In that study, SLE was defined using the 1982/1997 ACR classification criteria, and disease duration could have been up to 5 years at cohort entry. For their own study, Ugarte-Gil and colleagues included 640 LUMINA participants, and compared those who achieved the 2019 criteria at any time during the follow-up with those who did not.
Predefined outcomes included the last Systemic Lupus International Collaborating Clinics (SLICC)/ACR damage index (SDI) and survival. Possible confounders included were age, sex, race or ethnicity, poverty, disease duration at baseline, baseline disease activity, baseline SDI, and any antimalarial, glucocorticoid and immunosuppressive drugs use at baseline. The researchers performed univariable and multivariable negative binomial regression models, with adjustment models based on a forward selection process.
According to the researchers, 98 of the 640 included participants achieved the 2019 EULAR/ACR criteria for SLE. There was no difference in mean baseline SDI among the patients who did not achieve the criteria, compared with those who did. However, the mean SDI at last visit was lower among patients who never achieved the 2019 criteria, at 1.2 ± 1.7, compared with 2 ± 2.3 among those who did met the criteria (P = .0004). In the final adjusted model, the SDI score at last visit was 31% lower among those who failed to meet the criteria (P = .0077).
“Patients who achieved these criteria accrued more damage than those who did not, even though those who did not achieve the criteria were classified as having SLE with the 1982/1997 ACR criteria,” Ugarte-Gil said. “Patients who did not achieve the EULAR/ACR criteria could have a milder form of the disease. Potentially, these criteria may be useful in predicting prognosis and not only to classify patients earlier or not.”