Cited by 5,322Systemic Lupus Erythematosus ResearchSystemic Sclerosis and Related DiseasesVasculitis and related conditions

Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus

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Petri, Michelle, Orbai, Ana‐Maria, Alarcón, Graciela S., Gordon, Caroline, Merrill, Joan T., Fortin, Paul R., Bruce, Ian N., Isenberg, David +44 more·2012·Arthritis & Rheumatism

Abstract

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.

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  • For detection of anti-dsDNA antibodies only limited requirements for test characteristics were defined, varying from 'increased titer', 'above laboratory reference range (except for ELISA)', to '>90% specificity'.

    “For detection of anti-dsDNA antibodies only limited requirements for test characteristics were defined, varying from ‘increased titer’ [16,17], ‘above laboratory reference range (except for ELISA)’ [18], to ‘>90% specificity’ [19].”

    From Anti-dsDNA antibodies in the classification criteria of systemic lupus erythematosus (2022) · cites this paper as [18]

    The Discussion (page unavailable) says the SLICC anti-dsDNA criterion requires a stricter cut-off for ELISA assays, supporting the cited distinction between ELISA and other tests. The passages in our copy do not specify an ‘above laboratory reference range’ threshold for non-ELISA tests, so the precise requirement attributed to this source is not verified. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • The SLICC criteria published in 2012 showed that, although highly specific, the sensitivity of the ACR classification criteria for SLE was suboptimal, especially in new-onset SLE.

    “The Systemic Lupus International Collaborating Clinics (SLICC) criteria published in 2012 showed that, although highly specific, the sensitivity of the ACR classification criteria for SLE was suboptimal, especially in new-onset SLE.”

    From Anti-dsDNA antibodies in the classification criteria of systemic lupus erythematosus (2022) · cites this paper as [18]

    The Results report that the ACR criteria had 83% sensitivity and 96% specificity in the validation set, supporting the comparison of lower sensitivity with high specificity. Neither the Results nor the Discussion passages establish that sensitivity was especially suboptimal in new-onset SLE; no new-onset subgroup result was found. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Anti-dsDNA testing is an essential part of the diagnosis, classification, and management of SLE.

    “Consequently, anti-dsDNA testing is an essential part of the diagnosis, classification, and management of SLE (2,3,(11)(12)(13)”

    From Anti-dsDNA Testing Specificity for Systemic Lupus Erythematosus: A Systematic Review. (2022) · cites this paper as [3]

    The Discussion says anti-dsDNA is a separate SLICC classification criterion and that anti-dsDNA antibodies, alongside biopsy-confirmed nephritis, can suffice for classification. It does not establish that anti-dsDNA testing is essential for every SLE diagnosis or for disease management; the criteria also allow alternatives such as ANA. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • The 2012 SLICC criteria proposed to classify only patients that have at least one immunologic criterion, overcoming SLE classification based solely on clinical manifestations.

    “These criteria proposed to classify only patients that have at least one immunologic criterion, overcoming SLE classification based solely on clinical manifestations.”
  • Patients without the listed autoantibodies or low complement cannot be classified as having SLE.

    “Accordingly, patients without the listed autoantibodies or low complement cannot be classified as having SLE.”

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Authors
Petri, M., Orbai, A., Alarcón, G. S., Gordon, C., Merrill, J. T., Fortin, P. R., Bruce, I. N., Isenberg, D., Wallace, D. J., Nived, O., Sturfelt, G., Ramsey‐Goldman, R., Bae, S., Hanly, J. G., Sánchez‐Guerrero, J., Clarke, A., Aranow, C., Manzi, S., Urowitz, M., Gladman, D., Kalunian, K., Costner, M., Werth, V. P., Zoma, A., Bernatsky, S., Ruiz‐Irastorza, G., Khamashta, M. A., Jacobsen, S., Buyon, J. P., Maddison, P., Dooley, M. A., van Vollenhoven, R. F., Ginzler, E., Stoll, T., Peschken, C., Jorizzo, J. L., Callen, J. P., Lim, S. S., Fessler, B. J., Inanc, M., Kamen, D. L., Rahman, A., Steinsson, K., Franks, A. G., Sigler, L., Hameed, S., Fang, H., Pham, N., Brey, R., Weisman, M. H., McGwin, G., & Magder, L. S.
Affiliations
  • Johns Hopkins University (US)
  • University of Alabama at Birmingham (US)
  • University of Birmingham (GB)
  • Oklahoma Medical Research Foundation (US)
  • Centre hospitalier universitaire de Québec (CA)
  • Manchester Academic Health Science Centre (GB)
  • Cedars-Sinai Medical Center (US)
  • Skåne University Hospital (SE)
  • Northwestern University (US)
  • Dalhousie University (CA)
  • Mount Sinai Hospital (CA)
  • Feinstein Institute for Medical Research (US)
  • Toronto Western Hospital (CA)
  • University of California San Diego (US)
  • University of Pennsylvania (US)
  • Hairmyres Hospital (GB)
  • McGill University Health Centre (CA)
  • University of the Basque Country (ES)
  • St Thomas' Hospital (GB)
  • New York University (US)
  • Ysbyty Gwynedd Hospital NHS Trust (GB)
  • University of North Carolina at Chapel Hill (US)
  • Karolinska University Hospital (SE)
  • SUNY Downstate Health Sciences University (US)
  • Spitäler Schaffhausen (CH)
  • Atrium Health Wake Forest Baptist (US)
  • University of Louisville (US)
  • Emory University (US)
  • Medical University of South Carolina (US)
  • University of Maryland, Baltimore (US)
Corresponding author
Petri, Michelle
Venue
Arthritis & Rheumatism
Publisher
Wiley
Published
2012-07-27
Volume
64
Issue
8
Pages
2677-2686
ISSN
  • 0004-3591 (ISSN-L)
  • 1529-0131
OpenAlex
W2159860161
Cited by
5,322
References
38
Citations by year
2026: 322 · 2025: 421 · 2024: 454 · 2023: 507 · 2022: 550 · 2021: 572 · 2020: 524 · 2019: 450 · 2018: 415 · 2017: 343 · 2016: 282 · 2015: 220 · 2014: 163 · 2013: 78 · 2012: 13
FWCI
116.60
Type
journal article
Language
en
Open access
Locations
  • Arthritis & Rheumatism (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
  • SUNY Digital Repository Support (State University of New York System) (submittedVersion, cc-by-nc-nd)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • Hirsla (Landspítali University Hospital) (submittedVersion)
Funders
  • National Institutes of Health (UL1TR000150)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR043727, U01AR051871, T32AR048522)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Systemic Sclerosis and Related Diseases
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vasculitis and related conditions
Keywords
systemic lupus erythematosus, classification criteria, SLICC criteria, ACR classification criteria, diagnostic accuracy, sensitivity and specificity, recursive partitioning, lupus nephritis, antinuclear antibodies, anti-dsDNA antibodies
MeSH terms
Antibodies, Anti-Idiotypic, Antibodies, Antinuclear, Biopsy, DNA, Humans, International Agencies, Lupus Erythematosus, Systemic, Lupus Nephritis, Sensitivity and Specificity

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