Relationship between the EULAR/ACR classification criteria and organ damage in systemic lupus erythematosus

Abstract

Objectives

To study the relationship between the 2019 EULAR/ACR classification criteria and organ damage in patients with systemic lupus erythematosus (SLE).

Methods

Patients involved in a cross-sectional validation study of the EULAR/ACR criteria and judged by a panel of rheumatologists to be clinical SLE were studied. Those who fulfilled the EULAR/ACR criteria at their last clinic visit were stratified into 2 groups based on a cutoff score of 20. The last SLE International Collaborating Clinic (SLICC) Organ Damage Index (SDI) was compared between these two groups. Relationship among the domains of the EULAR/ACR criteria and SDI in all patients was studied by using Spearman’s rank correlation.

Results

A total of 562 SLE patients were studied (93.6% women; age 36.5 ± 14.1 years; follow-up duration 11.6 ± 6.6 years). The mean and median EULAR/ACR criteria scores in those who fulfilled the EULAR/ACR criteria (N = 542) were 24.6 ± 7.3 and 24 (interquartile range 19–30), respectively. A total of 392 patients had EULAR/ACR scores of ≥20 (group 1), and 150 patients had scores of 10–19 (group 2). Group 1 patients had significantly higher prevalence of fever, alopecia, oral ulcers, acute lupus skin lesions, arthritis, serositis, seizure, hemolytic anemia, leukopenia, and renal disease and so were the anti-dsDNA, anti-Sm, antiphospholipid antibodies, and low complement state. Organ damage (SDI score of ≥1) occurred in 232 (42.8%) patients. Patients in group 1 had significantly higher SDI scores in the renal, cardiovascular, dermatological, and gonadal domains than group 2. The renal, neuropsychiatric, and antiphospholipid antibody domain scores of the EULAR/ACR criteria correlated positively with the total SDI. The renal domain of the EULAR/ACR criteria had the strongest correlation with renal damage (Rho 0.30; p < 0.001). Patients who scored 10 points in the renal domain had significantly higher renal damage score than those scored 8 points or 4 points. Gonadal damage score was also significantly more common in the 10-point than in the 8-point group.

Conclusion

In addition to disease classification, the EULAR/ACR SLE criteria may have value in predicting prognosis.

Keywords

Criteria classification prognosis damage lupus

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References

Aringer

Costenbader

Daikh

, et al. European league against rheumatism/american college of rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis 2019; 78: 1151–1159.

Chung

Lee

, et al. Validation of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in ANA positive Chinese patients. Ther Adv Musculoskelet Dis 2022; 14: 1759720X221100300. [in press].

Carneiro

Ruiz

Freitas

, et al. Comparison of three classification criteria sets for systemic lupus erythematosus: a study looking at links to outcome and mortality. Arthritis Care Res (Hoboken) 2020; 72: 1611–1614.

Insfrán

Aikawa

Pasoto

, et al. EULAR/ACR classification criteria domains at diagnosis: predictive factors of long-term damage in systemic lupus erythematosus. Clin Rheumatol 2019; 41: 1079–1085.

Pitta

Silva

Insfrán

, et al. The new 2019-EULAR/ACR classification criteria specific domains at diagnosis can predict damage accrual in 670 childhood-onset systemic lupus erythematosus patients. Lupus 2021; 30: 2286–2291.

Whittall Garcia

Gladman

Urowitz

, et al. New EULAR/ACR 2019 SLE classification criteria: defining ominosity in SLE. Ann Rheum Dis 2021; 80: 767–774. annrheumdis-2020-218670.

Gladman

Ginzler

Goldsmith

, et al. The development and initial validation of the systemic lupus international collaborating clinics/American college of rheumatology damage index for systemic lupus erythematosus. Arthritis and Rheumatism 1996; 39: 363–369.

Ugarte-Gil

Pons-Estel

Griffin

, et al. Achievement of the 2019 european alliance of associations for rheumatology/american college of rheumatology criteria for systemic lupus erythematosus and amount of damage accrual: results from a multiethnic multicenter cohort. Arthritis Care Res (Hoboken) 2021; 73: 1038–1040.

Hochberg

. Updating the american college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40: 1725.

10.

Petri

Orbai

Alarcõn

, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis and rheumatism 2012; 64: 2677–2686.