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

Michelle Petri; Ana-Maria Orbai; Graciela S Alarcón; Caroline Gordon; Joan T Merrill; Paul R Fortin; Ian N Bruce; David Isenberg; Daniel J Wallace; Ola Nived; Gunnar Sturfelt; Rosalind Ramsey-Goldman; Sang-Cheol Bae; John G Hanly; Jorge Sánchez-Guerrero; Ann Clarke; Cynthia Aranow; Susan Manzi; Murray Urowitz; Dafna Gladman; Kenneth Kalunian; Melissa Costner; Victoria P Werth; Asad Zoma; Sasha Bernatsky; Guillermo Ruiz-Irastorza; Munther A Khamashta; Soren Jacobsen; Jill P Buyon; Peter Maddison; Mary Anne Dooley; Ronald F van Vollenhoven; Ellen Ginzler; Thomas Stoll; Christine Peschken; Joseph L Jorizzo; Jeffrey P Callen; S Sam Lim; Barri J Fessler; Murat Inanc; Diane L Kamen; Anisur Rahman; Kristjan Steinsson; Andrew G Franks; Lisa Sigler; Suhail Hameed; Hong Fang; Ngoc Pham; Robin Brey; Michael H Weisman; Gerald McGwin; Laurence S Magder

doi:10.1002/art.34473

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

Michelle Petri, Ana-Maria Orbai, Graciela S Alarcón, Caroline Gordon, Joan T Merrill, Paul R Fortin, Ian N Bruce, David Isenberg, Daniel J Wallace, Ola Nived, Gunnar Sturfelt, Rosalind Ramsey-Goldman, Sang-Cheol Bae, John G Hanly, Jorge Sánchez-Guerrero, Ann Clarke, Cynthia Aranow, Susan Manzi, Murray Urowitz, Dafna GladmanKenneth Kalunian, Melissa Costner, Victoria P Werth, Asad Zoma, Sasha Bernatsky, Guillermo Ruiz-Irastorza, Munther A Khamashta, Soren Jacobsen, Jill P Buyon, Peter Maddison, Mary Anne Dooley, Ronald F van Vollenhoven, Ellen Ginzler, Thomas Stoll, Christine Peschken, Joseph L Jorizzo, Jeffrey P Callen, S Sam Lim, Barri J Fessler, Murat Inanc, Diane L Kamen, Anisur Rahman, Kristjan Steinsson, Andrew G Franks, Lisa Sigler, Suhail Hameed, Hong Fang, Ngoc Pham, Robin Brey, Michael H Weisman, Gerald McGwin, Laurence S Magder

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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.

Original language	English
Journal	Arthritis & Rheumatism
Volume	64
Issue number	8
Pages (from-to)	2677-86
Number of pages	10
ISSN	0004-3591
DOIs	https://doi.org/10.1002/art.34473
Publication status	Published - Aug 2012

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Petri, M., Orbai, A-M., 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-C., Hanly, J. G., Sánchez-Guerrero, J., Clarke, A., Aranow, C., Manzi, S., Urowitz, M., ... Magder, L. S. (2012). Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis & Rheumatism, 64(8), 2677-86. https://doi.org/10.1002/art.34473

Petri, M, Orbai, A-M, Alarcón, GS, Gordon, C, Merrill, JT, Fortin, PR, Bruce, IN, Isenberg, D, Wallace, DJ, Nived, O, Sturfelt, G, Ramsey-Goldman, R, Bae, S-C, 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 & Rheumatism, vol. 64, no. 8, pp. 2677-86. https://doi.org/10.1002/art.34473

@article{b17d8010b7f74b1d8d7a39481961e230,

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

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.",

author = "Michelle Petri and Ana-Maria Orbai and Alarc{\'o}n, {Graciela S} and Caroline Gordon and Merrill, {Joan T} and Fortin, {Paul R} and Bruce, {Ian N} and David Isenberg and Wallace, {Daniel J} and Ola Nived and Gunnar Sturfelt and Rosalind Ramsey-Goldman and Sang-Cheol Bae and Hanly, {John G} and Jorge S{\'a}nchez-Guerrero and Ann Clarke and Cynthia Aranow and Susan Manzi and Murray Urowitz and Dafna Gladman and Kenneth Kalunian and Melissa Costner and Werth, {Victoria P} and Asad Zoma and Sasha Bernatsky and Guillermo Ruiz-Irastorza and Khamashta, {Munther A} and Soren Jacobsen and Buyon, {Jill P} and Peter Maddison and Dooley, {Mary Anne} and {van Vollenhoven}, {Ronald F} and Ellen Ginzler and Thomas Stoll and Christine Peschken and Jorizzo, {Joseph L} and Callen, {Jeffrey P} and Lim, {S Sam} and Fessler, {Barri J} and Murat Inanc and Kamen, {Diane L} and Anisur Rahman and Kristjan Steinsson and Franks, {Andrew G} and Lisa Sigler and Suhail Hameed and Hong Fang and Ngoc Pham and Robin Brey and Weisman, {Michael H} and Gerald McGwin and Magder, {Laurence S}",

note = "Copyright {\textcopyright} 2012 by the American College of Rheumatology.",

year = "2012",

month = aug,

doi = "10.1002/art.34473",

language = "English",

volume = "64",

pages = "2677--86",

journal = "Arthritis & Rheumatology",

issn = "2326-5205",

publisher = "Wiley",

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TY - JOUR

T1 - Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus

AU - Petri, Michelle

AU - Orbai, Ana-Maria

AU - Alarcón, Graciela S

AU - Gordon, Caroline

AU - Merrill, Joan T

AU - Fortin, Paul R

AU - Bruce, Ian N

AU - Isenberg, David

AU - Wallace, Daniel J

AU - Nived, Ola

AU - Sturfelt, Gunnar

AU - Ramsey-Goldman, Rosalind

AU - Bae, Sang-Cheol

AU - Hanly, John G

AU - Sánchez-Guerrero, Jorge

AU - Clarke, Ann

AU - Aranow, Cynthia

AU - Manzi, Susan

AU - Urowitz, Murray

AU - Gladman, Dafna

AU - Kalunian, Kenneth

AU - Costner, Melissa

AU - Werth, Victoria P

AU - Zoma, Asad

AU - Bernatsky, Sasha

AU - Ruiz-Irastorza, Guillermo

AU - Khamashta, Munther A

AU - Jacobsen, Soren

AU - Buyon, Jill P

AU - Maddison, Peter

AU - Dooley, Mary Anne

AU - van Vollenhoven, Ronald F

AU - Ginzler, Ellen

AU - Stoll, Thomas

AU - Peschken, Christine

AU - Jorizzo, Joseph L

AU - Callen, Jeffrey P

AU - Lim, S Sam

AU - Fessler, Barri J

AU - Inanc, Murat

AU - Kamen, Diane L

AU - Rahman, Anisur

AU - Steinsson, Kristjan

AU - Franks, Andrew G

AU - Sigler, Lisa

AU - Hameed, Suhail

AU - Fang, Hong

AU - Pham, Ngoc

AU - Brey, Robin

AU - Weisman, Michael H

AU - McGwin, Gerald

AU - Magder, Laurence S

PY - 2012/8

Y1 - 2012/8

N2 - 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.

AB - 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.

U2 - 10.1002/art.34473

DO - 10.1002/art.34473

M3 - Journal article

C2 - 22553077

SN - 2326-5205

VL - 64

SP - 2677

EP - 2686

JO - Arthritis & Rheumatology

JF - Arthritis & Rheumatology

IS - 8

ER -

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

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