SLICC PI: DR. MICHELLE PETRI

SLICC classification criteria for Systemic Lupus Erythematosus

New Investigator: Dr. Ana-Maria Orbai Funding Source: National Institutes of Health

Seventeen criteria were identified in a very time-consuming and laborious process which involved the consensus diagnosis of over 700 patient scenarios, the reduction in the number of potential variables by extensive logistic regression analyses, the use of recursive portioning to derive classification rules and the refinement of the rules when agreement was not achieved. In a second step, another set of over 600 patient scenarios was used to validate the criteria. This process took well over a decade from its conception to publication.

The SLICC criteria for SLE classification requires: 1) Fulfillment of at least four criteria, with at least one clinical criterion AND one immunologic criterion OR 2) Lupus nephritis as the sole clinical criterion in the presence of ANA or anti-dsDNA antibodies.

Clinical Criteria:

1. Acute cutaneous lupus

2. Chronic cutaneous lupus

3. Oral ulcers: palate

4. Nonscarring alopecia (diffuse thinning or hair fragility with visible broken hairs)

5. Synovitis involving two or more joints, characterized by swelling or effusion OR tenderness in two or more joints and thirty minutes or more of morning stiffness.

6. Serositis

7. Renal

8. Neurologic

9. Hemolytic anemia

10. Leukopenia (< 4000/mm3 at least once)

11. Thrombocytopenia (<100,000/mm3) at least once

Immunological Criteria

1. ANA above laboratory reference range

2. Anti-dsDNA above laboratory reference range, except ELISA: twice above laboratory

3. Anti-Sm

4. Antiphospholipid antibody: any of the following

5. Low complement

6. Direct Coombs test in the absence of hemolytic anemia


References:

  • 1.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 SC, Hanly JG, Sanchez-Guerrero J, Clarke A, Aranow C, Manzi S, Urowitz MB, Gladman DD, Kalunian K, Costner M, Werth V, Zoma A, Bernatsky S, Ruiz-Irastorza G, Khamashta M, Jacobsen S, Buyon JP, Maddison P, Dooley MA, Van Vollenhoven R, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim S, Fessler BJ, Inanc M, Kamen DL, Rahman A, Steinsson K, Franks Jr. AG , Sigler L, Hameed S, Fang H, Pham N, Brey R, Weisman MH, McGwin Jr. G, Magder LS.  Derivation and validation of Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for systemic lupus erythematosus.  Arthritis Rheum 2012; 64:2677-2686.  
  • 2.Navarra SV, Guzmán RM, Gallacher AE, Hall S, Levy RA, Jimenez RE, Li EK-M, Thomas M, Kim H-Y, León MG, Tanasescu C, Nasonov E, Lan J-L, Pinela L, Zhong ZJ, Freimuth W, Petri MA, for the BLISS-52 Study Group.  Efficacy and safety of belimumab in patients with active ssytemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial.  Lancet 2011; 377:721-731.

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