AB0303 VALIDATION OF THE THREE CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) ON A PATIENT COHORT FROM A V.A. NASONOVA SCIENTIFIC RESEARCH INSTITUTE OF RHEUMATOLOGY: A PROSPECTIVE STUDY
Authors: T. Reshetnyak, A. Shumilova, S. Glukhova, F. Cheldieva, T. Lisitsyna, N. Seredavkina, A. Lila
Journal: Annals of the Rheumatic Diseases (2021)

Background: Classification criteria for SLE need validation and selection of the most advanced ones for clinical practice Objectives: To validate Systemic Lupus International Collaborating Clinics (SLICC)-12, American College of Rheumatology (ACR)-97 and 2019 European League against Rheumatism/American College of Rheumatology (EULAR/ACR-2019) for Systemic Lupus Erythematosus classification criteria on a patient cohort from V.A. Nasonova Scientific Research Institute of Rheumatology (Moscow) Methods: This prospective study included 252 (n=152 with SLE and n=100 non SLE: 74 – with systemic sclerosis (SC) and 26 – with primary antiphospholipid syndrome (pAPS)) patients who were sequentially admitted to the 4th Rheumatology Department from December 2018 to June 2020. All of the patient records were reevaluated by expert rheumatologist in order to determine if they agree with the diagnosis. For every patient, a check-list of SLE-related features was filled out. The association between clinical diagnosis and diagnosis generated on the basis of ACR-97, SLICC-12 and EULAR/ACR-2019classification criteria was assessed. The overall sensitivity and specificity of ACR-97, SLICC-12 and EULAR/ACR-2019 classifications, as well as the sensitivity and specificity according to disease duration was calculated. The predictive value of every criterion in ACR-97, SLICC-12 and 2019 EULAR/ACR classification was assessed using logistic regression analysis and receiver operating characteristic (ROC) curves. Results: According to ACR-97 criteria, reliable SLE was diagnosed in 131 (86%), according to SLICC-2012 – in 145 (95.3%) and according to EULAR/ACR-2019 – in 144 (94.7%) of 152 patients, respectively. We identified the criteria that were significantly more represented in the SLE-group. The sensitivity and specificity (Table 1) did not change depending on the ANA titers (1/160 and 1/320) and the duration of the disease. Table 1. The sensitivity and specificity of SLE criteria in 152 SLE patients and 100 non SLE patients SLE classification criteria AUC, 95% CI Cut point Sensivity Specifity ACR-97 0.654 (0.550-0.758) 4 89.7 36 SLICC-12 0.616 (0.505-0.728) 4 93.1 43 2019 EULAR/ACR 0.609 (0.492-0.727) 10* 97.4 48 Note. ACR-97 – American College of Rheumatology classification from 1997; SlICC-12 – Systemic lupus International Collaboration Clinics classification from 2012; 2019 European League Against Rheumatism/American College of Rheumatology. ANA – anti-nuclear antibody more than 1/320 n=116; ANA &lt; 320 n= 36. AUC – area under the ROC curve; Cut point - reference point for the number of criteria, * number of points ≥ 10. When excluding patients with SC in a single-factor logistic model of patients with SLE and pAPS, indicating the number of criteria, the sensitivity was for ACR-97 - 86, for SlICC-12 - 95, for 2019 EULAR/ACR - 95, the specificity was 100, 62 and 62, respectively. Conclusion: Evaluation of the criteria by level ANA revealed the highest sensitivity for 2019 EULAR/ACR and SLICC-12, the specificity was low for all three criteria. In the analysis of patients with SLE and pAPS, the sensitivity was highest for 2019 EULAR/ACR and SLICC-12, the specificity was 100 for ACR-97. Disclosure of Interests: None declared