Open AccessDerivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus
Author(s) -
Petri Michelle,
Orbai AnaMaria,
Alarcón Graciela S.,
Gordon Caroline,
Merrill Joan T.,
Fortin Paul R.,
Bruce Ian N.,
Isenberg David,
Wallace Daniel J.,
Nived Ola,
Sturfelt Gunnar,
RamseyGoldman Rosalind,
Bae SangCheol,
Hanly John G.,
SánchezGuerrero Jorge,
Clarke Ann,
Aranow Cynthia,
Manzi Susan,
Urowitz Murray,
Gladman Dafna,
Kalunian Kenneth,
Costner Melissa,
Werth Victoria P.,
Zoma Asad,
Bernatsky Sasha,
RuizIrastorza Guillermo,
Khamashta Munther A.,
Jacobsen Soren,
Buyon Jill P.,
Maddison Peter,
Dooley Mary Anne,
van Vollenhoven Ronald F.,
Ginzler Ellen,
Stoll Thomas,
Peschken Christine,
Jorizzo Joseph L.,
Callen Jeffrey P.,
Lim S. Sam,
Fessler Barri J.,
Inanc Murat,
Kamen Diane L.,
Rahman Anisur,
Steinsson Kristjan,
Franks Andrew G.,
Sigler Lisa,
Hameed Suhail,
Fang Hong,
Pham Ngoc,
Brey Robin,
Weisman Michael H.,
McGwin Gerald,
Magder Laurence S.
Publication year - 2012
Publication title -
arthritis & rheumatism
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/art.34473
Subject(s) - medicine , rheumatology , systemic lupus erythematosus , anti nuclear antibody , lupus nephritis , machine learning , immunology , autoantibody , antibody , disease , computer science
Objective The Systemic Lupus International Collaborating Clinics (SLICC) group revised and validated the American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria in order to improve clinical relevance, meet stringent methodology requirements, and incorporate new knowledge regarding the immunology of SLE. Methods The classification criteria were derived from a set of 702 expert‐rated patient scenarios. Recursive partitioning was used to derive an initial rule that was simplified and refined based on SLICC physician consensus. The SLICC group validated the classification criteria in a new validation sample of 690 new expert‐rated patient scenarios. Results Seventeen criteria were identified. In the derivation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (49 versus 70; P = 0.0082) and had greater sensitivity (94% versus 86%; P < 0.0001) and equal specificity (92% versus 93%; P = 0.39). In the validation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (62 versus 74; P = 0.24) and had greater sensitivity (97% versus 83%; P < 0.0001) but lower specificity (84% versus 96%; P < 0.0001). Conclusion The new SLICC classification criteria performed well in a large set of patient scenarios rated by experts. According to the SLICC rule for the classification of SLE, the patient must satisfy at least 4 criteria, including at least one clinical criterion and one immunologic criterion OR the patient must have biopsy‐proven lupus nephritis in the presence of antinuclear antibodies or anti–double‐stranded DNA antibodies.