Systemic lupus erythematosus diagnostic criteria: Difference between revisions
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| rowspan="8" |<small>Clinical</small> | | rowspan="8" |<small>Clinical</small> | ||
! style="background: #DCDCDC; " | Acute cutaneous lupus | |||
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* Lupus [[malar rash]] | * Lupus [[malar rash]] | ||
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** Nonindurated psoriaform and/or annular polycyclic [[lesions]] that resolve without [[scarring]], although occasionally with [[Postinflammatory hypopigmentation|postinflammatory dyspigmentation]] or [[Telangiectasia|telangiectasias]] | ** Nonindurated psoriaform and/or annular polycyclic [[lesions]] that resolve without [[scarring]], although occasionally with [[Postinflammatory hypopigmentation|postinflammatory dyspigmentation]] or [[Telangiectasia|telangiectasias]] | ||
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! style="background: #DCDCDC; " |Chronic cutaneous lupus | |||
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* Classic [[Discoid lupus|discoid rash]] | * Classic [[Discoid lupus|discoid rash]] | ||
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** Discoid lupus[[Lichen planus|/lichen planus]] overlap | ** Discoid lupus[[Lichen planus|/lichen planus]] overlap | ||
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! style="background: #DCDCDC; " |Nonscarring [[alopecia]] | |||
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* Diffuse thinning or hair fragility with visible broken hairs (in the absence of other causes, such as [[alopecia areata]], drugs, [[iron deficiency]], and [[androgenic alopecia]]) | * Diffuse thinning or hair fragility with visible broken hairs (in the absence of other causes, such as [[alopecia areata]], drugs, [[iron deficiency]], and [[androgenic alopecia]]) | ||
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! style="background: #DCDCDC; " |[[Oral ulcer|Oral]] or nasal ulcers | |||
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* [[Palate]], [[buccal]], [[tongue]], or nasal [[ulcers]] (in the absence of other causes, such as [[vasculitis]], [[Behçet's disease]], [[infection]], [[inflammatory bowel disease]], [[reactive arthritis]], and acidic foods) | * [[Palate]], [[buccal]], [[tongue]], or nasal [[ulcers]] (in the absence of other causes, such as [[vasculitis]], [[Behçet's disease]], [[infection]], [[inflammatory bowel disease]], [[reactive arthritis]], and acidic foods) | ||
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! style="background: #DCDCDC; " |[[Arthralgia|Joint disease]] | |||
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* [[Synovitis]] involving two or more [[joints]], characterized by [[swelling]] or effusion | * [[Synovitis]] involving two or more [[joints]], characterized by [[swelling]] or effusion | ||
* [[Tenderness]] in two or more [[joints]] and at least 30 minutes of morning stiffness | * [[Tenderness]] in two or more [[joints]] and at least 30 minutes of morning stiffness | ||
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! style="background: #DCDCDC; " |[[Serositis]] | |||
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* Typical [[pleurisy]] for more than one day, [[Pleural effusion|pleural effusions]], or [[pleural]] rub | * Typical [[pleurisy]] for more than one day, [[Pleural effusion|pleural effusions]], or [[pleural]] rub | ||
* Typical pericardial pain (pain with recumbency improved by sitting forward) for more than one day, [[pericardial effusion]], pericardial rub, or [[pericarditis]] by [[electrocardiography]] in the absence of other causes, such as [[infection]], [[uremia]], and [[Dressler's syndrome]] | * Typical pericardial pain (pain with recumbency improved by sitting forward) for more than one day, [[pericardial effusion]], pericardial rub, or [[pericarditis]] by [[electrocardiography]] in the absence of other causes, such as [[infection]], [[uremia]], and [[Dressler's syndrome]] | ||
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! style="background: #DCDCDC; " |[[Renal]] | |||
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* Urine protein-to-[[creatinine]] ratio (or 24-hour urine protein) representing 500 mg protein/24 hours | * Urine protein-to-[[creatinine]] ratio (or 24-hour urine protein) representing 500 mg protein/24 hours | ||
* [[Red blood cell]] casts | * [[Red blood cell]] casts | ||
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! style="background: #DCDCDC; " |[[Neurological|Neurologic]] | |||
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* [[Seizure|Seizures]] | * [[Seizure|Seizures]] | ||
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| rowspan="3" |<small>[[Hematologic]]</small> | | rowspan="3" |<small>[[Hematologic]]</small> | ||
! style="background: #DCDCDC; " |[[Hemolytic anemia]] | |||
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* [[Hemoglobin]] less than 12 g/dL in females and 13 g/dL in males | * [[Hemoglobin]] less than 12 g/dL in females and 13 g/dL in males | ||
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! style="background: #DCDCDC; " |[[Leukopenia]] or [[lymphopenia]] | |||
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* [[Leukopenia]] (<4000/mm3 at least once) (in the absence of other known causes, such as [[Felty's syndrome]], [[drugs]], and [[portal hypertension]]) | * [[Leukopenia]] (<4000/mm3 at least once) (in the absence of other known causes, such as [[Felty's syndrome]], [[drugs]], and [[portal hypertension]]) | ||
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* [[Lymphopenia]] (<1000/mm3 at least once) (in the absence of other known causes, such as [[glucocorticoids]], [[drugs]], and [[infection]]) | * [[Lymphopenia]] (<1000/mm3 at least once) (in the absence of other known causes, such as [[glucocorticoids]], [[drugs]], and [[infection]]) | ||
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! style="background: #DCDCDC; " |[[Thrombocytopenia]] | |||
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* [[Thrombocytopenia]] (<100,000/mm3) at least once in the absence of other known causes, such as [[drugs]], [[portal hypertension]], and [[thrombotic thrombocytopenic purpura]] | * [[Thrombocytopenia]] (<100,000/mm3) at least once in the absence of other known causes, such as [[drugs]], [[portal hypertension]], and [[thrombotic thrombocytopenic purpura]] | ||
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| rowspan="6" |<small>[[Immunological|Immunologic]]</small> | | rowspan="6" |<small>[[Immunological|Immunologic]]</small> | ||
! style="background: #DCDCDC; " |[[ANA]] | |||
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* [[ANA]] level above laboratory reference range | * [[ANA]] level above laboratory reference range | ||
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! style="background: #DCDCDC; " |[[Anti-dsDNA antibody|Anti-dsDNA]] | |||
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* [[Anti-dsDNA antibody]] level above laboratory reference range (or >twofold the reference range if tested by [[Enzyme linked immunosorbent assay (ELISA)|ELISA]]) | * [[Anti-dsDNA antibody]] level above laboratory reference range (or >twofold the reference range if tested by [[Enzyme linked immunosorbent assay (ELISA)|ELISA]]) | ||
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! style="background: #DCDCDC; " |Anit-SM | |||
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* Presence of [[antibody]] to [[Smith antigen|Sm nuclear antigen]] | * Presence of [[antibody]] to [[Smith antigen|Sm nuclear antigen]] | ||
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! style="background: #DCDCDC; " |[[Antiphospholipid antibody|Antiphospholipid]] | |||
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* [[Antiphospholipid antibodies|Antiphospholipid antibody]] positivity as determined by any of the following: | * [[Antiphospholipid antibodies|Antiphospholipid antibody]] positivity as determined by any of the following: | ||
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** Positive test result for anti-beta 2-glycoprotein I ([[IgA]], [[IgG]], or [[IgM]]) | ** Positive test result for anti-beta 2-glycoprotein I ([[IgA]], [[IgG]], or [[IgM]]) | ||
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! style="background: #DCDCDC; " |Low [[complement]] | |||
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* Low [[C3 glomerular disease|C3]] | * Low [[C3 glomerular disease|C3]] | ||
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* Low CH50 | * Low CH50 | ||
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! style="background: #DCDCDC; " |[[Coombs' Test|Direct Coombs' test]] | |||
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* [[Coombs' Test|Direct Coombs' test]] in the absence of [[hemolytic anemia]] | * [[Coombs' Test|Direct Coombs' test]] in the absence of [[hemolytic anemia]] | ||
Latest revision as of 13:53, 17 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
Based on SLICC criteria, for an SLE diagnosis, the patient should have either at least 4 of 17 criteria, including at least 1 of the 11 clinical criteria and one of the six immunologic criteria (for each criterion, any bullet is considered as 1 clinical criteria), or a biopsy-proven nephritis compatible with SLE in the presence of antinuclear antibodies (ANA) or anti-double-stranded DNA (dsDNA) antibodies.
Diagnostic criteria
In 2012, Systemic Lupus International Collaboration Criteria (SLICC) developed a new criteria for SLE diagnosis. SLICC criteria for the classification of systemic lupus erythematosus was developed based on the old ACR criteria for the classification of systemic lupus erythematosus to address a more sensitive diagnostic criteria and also to cover weaknesses of the previous ACR criteria.[1][2]
Based on SLICC criteria, diagnosis of SLE is defined as:[3]
- Meeting at least 4 of 17 criteria, including at least 1 of the 11 clinical criteria and one of the six immunologic criteria
OR
- Biopsy-proven nephritis compatible with SLE in the presence of antinuclear antibodies (ANA) or anti-double-stranded DNA (dsDNA) antibodies
A criterion is considered positive if one or more of the observations listed in the definition for the criterion are present in the patient. A criterion should only be counted once, regardless of the number of observations in the definition that the patient presents with.
| Category | Criterion | Definition |
|---|---|---|
| Clinical | Acute cutaneous lupus |
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| Chronic cutaneous lupus |
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| Nonscarring alopecia |
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| Oral or nasal ulcers |
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| Joint disease |
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| Serositis |
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| Renal |
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| Neurologic |
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| Hematologic | Hemolytic anemia |
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| Leukopenia or lymphopenia |
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| Thrombocytopenia |
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| Immunologic | ANA |
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| Anti-dsDNA |
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| Anit-SM |
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| Antiphospholipid |
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| Low complement | ||
| Direct Coombs' test |
|
References
- ↑ Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, Schaller JG, Talal N, Winchester RJ (1982). "The 1982 revised criteria for the classification of systemic lupus erythematosus". Arthritis Rheum. 25 (11): 1271–7. PMID 7138600.
- ↑ Hochberg MC (1997). "Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus". Arthritis Rheum. 40 (9): 1725. doi:10.1002/1529-0131(199709)40:9<1725::AID-ART29>3.0.CO;2-Y. PMID 9324032.
- ↑ Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, Bruce IN, Isenberg D, Wallace DJ, Nived O, Sturfelt G, Ramsey-Goldman R, Bae SC, Hanly JG, Sánchez-Guerrero J, Clarke A, Aranow C, Manzi S, Urowitz M, Gladman D, Kalunian K, Costner M, Werth VP, Zoma A, Bernatsky S, Ruiz-Irastorza G, Khamashta MA, Jacobsen S, Buyon JP, Maddison P, Dooley MA, van Vollenhoven RF, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim SS, Fessler BJ, Inanc M, Kamen DL, Rahman A, Steinsson K, Franks AG, Sigler L, Hameed S, Fang H, Pham N, Brey R, Weisman MH, McGwin G, Magder LS (2012). "Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus". Arthritis Rheum. 64 (8): 2677–86. doi:10.1002/art.34473. PMC 3409311. PMID 22553077.