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Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus
Open accessAbstract
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’ [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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
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“These criteria proposed to classify only patients that have at least one immunologic criterion, overcoming SLE classification based solely on clinical manifestations.”
From Anti-dsDNA antibodies in the classification criteria of systemic lupus erythematosus (2022) · cites this paper as [18]
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“Accordingly, patients without the listed autoantibodies or low complement cannot be classified as having SLE.”
From Anti-dsDNA antibodies in the classification criteria of systemic lupus erythematosus (2022) · cites this paper as [18]
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“new classification criteria for SLE were issued in 2012 by the Systemic Lupus International Collaborating Clinics (SLICC)”
From Anti-dsDNA antibodies in the classification criteria of systemic lupus erythematosus (2022) · cites this paper as [18]
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“The new SLICC classification criteria contain several novelties compared to the ACR criteria [18].”
From Anti-dsDNA antibodies in the classification criteria of systemic lupus erythematosus (2022) · cites this paper as [18]
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“The existence of anti-dsDNA Abs in the absence of positive ANA results is thought to be a rare phenomenon that is attributed to laboratory errors [40].”
From Anti-double stranded DNA antibodies: A rational diagnostic approach in limited-resource settings (2022) · cites this paper as [40]
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“SLE was diagnosed and classified based on either the revised American College of Rheumatology10 or the Systemic Lupus International Collaborating Clinics classification criteria.11”
From Evaluation of different ways to identify persistent positivity of lupus anticoagulant in systemic lupus erythematosus (2020) · cites this paper as [11]
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“SLE patients were diagnosed according to revised ACR and SLICC criteria [23, 24].”
From Antiphospholipid patterns predict risk of thrombosis in systemic lupus erythematosus (2021) · cites this paper as [23]
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“Since 2012, the IgA isotype of the aPL has been accepted as a laboratory criterion for SLE in the SLICC SLE Classification Criteria [23].”
From Antiphospholipid patterns predict risk of thrombosis in systemic lupus erythematosus (2021) · cites this paper as [23]
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“The included studies used ACR 1982 (33), ACR 1997 (13), SLICC 2012 (3), or a combination of these classification criteria to define the SLE group.”
From Anti-dsDNA Testing Specificity for Systemic Lupus Erythematosus: A Systematic Review. (2022) · cites this paper as [3]
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Citations
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The classification of glomerulonephritis in systemic lupus erythematosus revisited
Weening, J. J., ON Behalf of the International Society of Nephrology and Renal Pathology Society Working Group on the Classification Oflupus Nephritis, D’Agati, V. D., Schwartz, M. M., Seshan, S. V., Alpers, C. E., Appel, G. B., Balow, J. E., Bruijn, J. A., Cook, T. H., et al. (2004) · Kidney International · doi:10.1111/j.1523-1755.2004.00443.x · Cited by 1,649
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Comparison of current methods for anti‐dsDNA antibody detection and reshaping diagnostic strategies
Infantino, M., Palterer, B., Previtali, G., Alessio, M., Villalta, D., Carbone, T., Platzgummer, S., Paura, G., Castiglione, C., Fabris, M., et al. (2022) · Scandinavian Journal of Immunology · doi:10.1111/sji.13220 · Cited by 20
Arriens, C., Aberle, T., Carthen, F., Kamp, S., Thanou, A., Chakravarty, E., James, J. A., Merrill, J. T., & Ogunsanya, M. E. (2020) · Lupus Science & Medicine · doi:10.1136/lupus-2019-000360 · Cited by 19
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Poole, J. L., Bradford, J. D., & Siegel, P. (2019) · American Journal of Occupational Therapy · doi:10.5014/ajot.2019.030619 · Cited by 16
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“11 This analysis was based on all cohort patients who had at least 16 lupus anticoagulant assessments after 2003 (excluding those on anticoagulants).”
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Self-citation
Metadata
- 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
- ORCID
- Petri, Michelle
- Orbai, Ana‐Maria
- Alarcón, Graciela S.
- Gordon, Caroline
- Merrill, Joan T.
- Fortin, Paul R.
- Bruce, Ian N.
- Isenberg, David
- Wallace, Daniel J.
- Nived, Ola
- Ramsey‐Goldman, Rosalind
- Bae, Sang‐Cheol
- Hanly, John G.
- Sánchez‐Guerrero, Jorge
- Clarke, Ann
- Aranow, Cynthia
- Manzi, Susan
- Urowitz, Murray
- Gladman, Dafna
- Kalunian, Kenneth
- Werth, Victoria P.
- Bernatsky, Sasha
- Ruiz‐Irastorza, Guillermo
- Khamashta, Munther A.
- Buyon, Jill P.
- Maddison, Peter
- Ginzler, Ellen
- Stoll, Thomas
- Peschken, Christine
- Jorizzo, Joseph L.
- Callen, Jeffrey P.
- Lim, S. Sam
- Kamen, Diane L.
- Rahman, Anisur
- Franks, Andrew G.
- Fang, Hong
- Brey, Robin
- Weisman, Michael H.
- McGwin, Gerald
- Magder, Laurence S.
- Venue
- Arthritis & Rheumatism
- Publisher
- Wiley
- Published
- 2012-07-27
- Volume
- 64
- Issue
- 8
- Pages
- 2677-2686
- ISSN
- 0004-3591 (ISSN-L)
- 1529-0131
- PMC
- PMC3409311
- 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
- green
- europepmc.org
- 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 › Rheumatology › Systemic Sclerosis and Related Diseases
- Health Sciences › Medicine › Rheumatology › 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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