Systemic lupus erythematosus diagnostic criteria: Difference between revisions
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{{CMG}}; {{AE}}{{MIR}} | {{CMG}}; {{AE}}{{MIR}} | ||
==Overview== | ==Overview== | ||
Based on SLICC criteria, for an SLE diagnosis: 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, | Based on SLICC criteria, for an SLE diagnosis: Patient should have either at least 4 of 17 criteria, including at least 1 of the 11 clinical criteria and one of the six [[Immunological|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|antinuclear antibodies (ANA)]] or [[Double stranded DNA antibody|anti-double-stranded DNA]] (dsDNA) [[antibodies]]. | ||
==Diagnostic criteria== | ==Diagnostic criteria== | ||
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Based on SLICC criteria, diagnosis of SLE is defined as:<ref name="pmid22553077">{{cite journal |vauthors=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 |title=Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus |journal=Arthritis Rheum. |volume=64 |issue=8 |pages=2677–86 |year=2012 |pmid=22553077 |pmc=3409311 |doi=10.1002/art.34473 |url=}}</ref> | Based on SLICC criteria, diagnosis of SLE is defined as:<ref name="pmid22553077">{{cite journal |vauthors=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 |title=Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus |journal=Arthritis Rheum. |volume=64 |issue=8 |pages=2677–86 |year=2012 |pmid=22553077 |pmc=3409311 |doi=10.1002/art.34473 |url=}}</ref> | ||
* At least 4 of 17 criteria, including at least 1 of the 11 clinical criteria and one of the six [[Immunological|immunologic]] criteria (for each criterion, any bullet is considered as 1 clinical criteria) | * At least 4 of 17 criteria, including at least 1 of the 11 clinical criteria and one of the six [[Immunological|immunologic]] criteria (for each criterion, any bullet is considered as 1 clinical criteria) | ||
'''OR''' | '''OR''' | ||
* Biopsy-proven [[nephritis]] compatible with [[SLE]] in the presence of [[Antinuclear antibodies|antinuclear antibodies (ANA)]] or [[Double stranded DNA antibody|anti-double-stranded DNA]] (dsDNA) [[antibodies]] | * Biopsy-proven [[nephritis]] compatible with [[SLE]] in the presence of [[Antinuclear antibodies|antinuclear antibodies (ANA)]] or [[Double stranded DNA antibody|anti-double-stranded DNA]] (dsDNA) [[antibodies]] | ||
{| class="wikitable" | {| class="wikitable" | ||
! | ! | ||
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* [[Bullous]] lupus | * [[Bullous]] lupus | ||
* [[Toxic epidermal necrolysis]] variant of SLE | * [[Toxic epidermal necrolysis]] variant of SLE | ||
* [[Maculopapular rash|Maculopapular]] lupus rash | * [[Maculopapular rash|Maculopapular]] lupus [[rash]] | ||
* [[Photosensitive]] lupus rash (in the absence of [[dermatomyositis]]); | * [[Photosensitive]] lupus [[rash]] (in the absence of [[dermatomyositis]]); | ||
** Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation | ** Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation | ||
* Subacute cutaneous lupus | * Subacute cutaneous lupus | ||
** 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]] | ||
|- | |- | ||
|Chronic cutaneous lupus | |Chronic cutaneous lupus | ||
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** Localized (above the neck) | ** Localized (above the neck) | ||
** Generalized (above and below the neck) | ** Generalized (above and below the neck) | ||
** Hypertrophic (verrucous) lupus | ** [[Hypertrophic]] (verrucous) lupus | ||
** Lupus [[panniculitis]] (profundus) | ** Lupus [[panniculitis]] (profundus) | ||
** [[Mucosal]] lupus | ** [[Mucosal]] lupus | ||
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|[[Oral ulcer|Oral]] or nasal ulcers | |[[Oral ulcer|Oral]] or nasal ulcers | ||
| | | | ||
* Palate, buccal, tongue, or nasal ulcers (in the absence of other causes, such as [[vasculitis]], [[Behçet's disease]], [[infection | * [[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) | ||
|- | |- | ||
|[[Arthralgia|Joint disease]] | |[[Arthralgia|Joint disease]] | ||
| | | | ||
* [[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 | ||
|- | |- | ||
|[[Serositis]] | |[[Serositis]] | ||
| | | | ||
* 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]] | ||
|- | |- | ||
|[[Renal]] | |[[Renal]] | ||
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* [[Mononeuritis multiplex]] (in the absence of other known causes, such as primary [[vasculitis]]) | * [[Mononeuritis multiplex]] (in the absence of other known causes, such as primary [[vasculitis]]) | ||
* [[Myelitis]] | * [[Myelitis]] | ||
* Peripheral or cranial neuropathy (in the absence of other known causes, such as primary [[vasculitis]], [[infection]], and [[diabetes mellitus]]) | * [[Peripheral neuropathy|Peripheral]] or [[Neuropathy|cranial neuropathy]] (in the absence of other known causes, such as primary [[vasculitis]], [[infection]], and [[diabetes mellitus]]) | ||
* Acute confusional state (in the absence of other causes, including toxic/metabolic, [[uremia]], drugs) | * [[Confusion|Acute confusional state]] (in the absence of other causes, including toxic/metabolic, [[uremia]], drugs) | ||
|- | |- | ||
| rowspan="6" |[[Hematologic]] | | rowspan="6" |[[Hematologic]] | ||
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|[[Leukopenia]] or [[lymphopenia]] | |[[Leukopenia]] or [[lymphopenia]] | ||
| | | | ||
* [[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]]) | ||
* [[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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|Anit-SM | |Anit-SM | ||
| | | | ||
* Presence of [[antibody]] to Sm nuclear antigen | * Presence of [[antibody]] to [[Smith antigen|Sm nuclear antigen]] | ||
|- | |- | ||
| rowspan="3" |[[Immunological|Immunologic]] | | rowspan="3" |[[Immunological|Immunologic]] | ||
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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]] | ||
|} | |} | ||
For counting the number of positive criterias, note that each one of the bullets within each one of tables is considered as 1 criteria, and if any of them are positive, the others are not counted!!!! | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 15:40, 27 July 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: 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]
- 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
- Biopsy-proven nephritis compatible with SLE in the presence of antinuclear antibodies (ANA) or anti-double-stranded DNA (dsDNA) antibodies
| Criterion | Definition | |
|---|---|---|
| Clinical | Acute cutaneous lupus |
|
| Chronic cutaneous lupus |
| |
| Nonscarring alopecia |
| |
| Oral or nasal ulcers |
| |
| Joint disease |
| |
| Serositis |
| |
| Renal |
| |
| Neurologic |
| |
| Hematologic | Hemolytic anemia |
|
| Leukopenia or lymphopenia |
| |
| Thrombocytopenia |
| |
| ANA |
| |
| Anti-dsDNA |
| |
| Anit-SM |
| |
| Immunologic | Antiphospholipid |
|
| Low complement | ||
| Direct Coombs' test |
|
For counting the number of positive criterias, note that each one of the bullets within each one of tables is considered as 1 criteria, and if any of them are positive, the others are not counted!!!!
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.