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Lerkvaleekul B, Chobchai P, Rattanasiri S, Vilaiyuk S. Evaluating performance of the 2019 EULAR/ACR, 2012 SLICC, and 1997 ACR criteria for classifying adult-onset and childhood-onset systemic lupus erythematosus: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1093213. [PMID: 36619627 PMCID: PMC9813386 DOI: 10.3389/fmed.2022.1093213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The American College of Rheumatology (ACR) 1997, Systemic Lupus International Collaborating Clinics (SLICC) 2012, and European League Against Rheumatism (EULAR)/ACR 2019 SLE criteria are often used to classify patients with adult-onset and childhood-onset systemic lupus erythematosus (SLE) in clinical practice because there are currently no diagnostic criteria for SLE. However, there is scarce evidence regarding which criteria are best for diagnosing patients with adult-onset and childhood-onset SLE. Methods We searched Medline and Scopus databases for English-language articles from inception through October 2021. Data were extracted from the included publications by two independent reviewers. We performed bivariate meta-analysis with a random-effects model to pool diagnostic parameters. Meta-regression and subgroup analyses were performed to explore heterogeneity sources. We used network meta-analysis to compare diagnosis performance among the three criteria and ranked them in descending order. Publication bias was assessed using Deeks' funnel plot. Results We included 29 studies for systematic review and meta-analysis. Of these, 18 studies involved adult-onset SLE and 11 studies involved childhood-onset SLE. The pooled sensitivities of the three criteria for diagnosis of adult-onset SLE were comparable between SLICC 2012 and EULAR/ACR 2019 [95.86, 95% confidence interval (CI) 92.28-97.81 vs. 94.79, 95% CI 92.03-96.63]; pooled specificity was highest in ACR 1997 (92.24, 95% CI 87.06-95.46). In childhood-onset SLE, pooled sensitivity was highest in SLICC 2012 (93.76, 95% CI 89.45-96.39), and pooled specificity was highest in ACR 1997 (95.89, 95% CI 91.73-98.00). In network meta-analysis, the pooled diagnostic odds ratio ranked highest for EULAR/ACR 2019 (131.570, 95% CI 61.50-281.47) in adult-onset SLE and ranked highest for SLICC 2012 (191.07, 95% CI 76.06-480.01) in childhood-onset SLE. Deeks' funnel plot showed no publication bias. Conclusion We found that the diagnostic performance of the ACR 1997, SLICC 2012, and EULAR/ACR 2019 criteria differed between adult-onset and childhood-onset SLE. EULAR/ACR 2019 performed best for adult-onset SLE and SLICC 2012 was best for childhood-onset SLE in classifying patients with SLE. Systematic review registration [www.ClinicalTrials.gov], identifier [CRD420 21281586].
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Affiliation(s)
- Butsabong Lerkvaleekul
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pantira Chobchai
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Soamarat Vilaiyuk
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,*Correspondence: Soamarat Vilaiyuk,
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Pandey A, Parajuli S, Dhungel A, Devkota R, Dangol A. Etoricoxib Induced Toxic Epidermal Necrolysis in a case of Systemic Lupus Erythematosus: A Case Report. JNMA J Nepal Med Assoc 2022; 60:811-814. [PMID: 36705131 PMCID: PMC9794938 DOI: 10.31729/jnma.7665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/25/2022] [Indexed: 02/02/2023] Open
Abstract
Toxic epidermal necrolysis is a potentially life-threatening dermatological condition whose pathogenesis and exact treatment are not yet known. Drugs like anticonvulsants, allopurinol and non-steroidal anti-inflammatory drugs like etoricoxib, a selective cyclo-oxygenase-2 inhibitor prescribed for pain management are associated with a high risk of toxic epidermal necrolysis. It is also associated with immunodeficiency and dysregulated immune reactions like systemic lupus erythematosus, an autoimmune disease in which organs and cells undergo damage initially mediated by tissue binding auto-antibodies and immune complexes. Here, a 34 year old lady was presented in emergency with multiple maculopapular rashes over the neck and trunk region after treatment with etoricoxib for osteoarthritis of the left foot.
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Affiliation(s)
- Asim Pandey
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal,Correspondence: Dr Asim Pandey, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal. , Phone: +977-9843614145
| | - Samriddhi Parajuli
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Alok Dhungel
- Department of Internal Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Rahul Devkota
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Angel Dangol
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Adult pure red cell aplasia at Universitas Academic Hospital, Bloemfontein, South Africa: A 9-year review. S Afr Med J 2022; 112:753-759. [DOI: 10.7196/samj.2022.v112i9.16416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
Background. Pure red cell aplasia (PRCA) is characterised by severe normochromic, normocytic anaemia and partial or complete absence of reticulocytes from the peripheral blood. With bone marrow of normal cellularity, an almost complete absence of erythroblasts but preservation of other cell lines is observed. It may be congenital or acquired, with the latter presenting as a primary haematological disorder or secondary to various contributing factors. Management focuses on treatment of the underlying cause and supportive transfusions. Occasionally, immunosuppression or intravenous immunoglobulin (IVIG) is required.Objectives. To describe the clinical characteristics, treatment and outcomes of adult patients diagnosed with PRCA at Universitas Academic Hospital (UAH) in Bloemfontein, South Africa, from 2010 to 2018.Methods. A retrospective descriptive file review was performed. All adult patients diagnosed with PRCA and treated in the Division of Clinical Haematology at UAH during the study period were included. Variables recorded included demographic information, clinical details of the PRCA diagnosis, classification of the PRCA, HIV and parvovirus B19 test results, results of special investigations, medical and drug history, treatment and response to treatment.Results. Twenty-seven patients’ files were included, with a female predominance (n=22; 81.5%). The median age at diagnosis was 35 years (range 20 - 62). The median number of days from onset of symptoms to date of diagnosis was 61 days (range 27 - 114). Approximately half (n=13; 48.2%) of the patients presented with a haemoglobin concentration of 1 - 3 g/dL. Most patients (n=26; 96.3%) were infected with HIV, with 76.9% (n=20) having a suppressed viral load. Parvovirus B19 infection accounted for 44.4% of cases (n=12), and all these patients were HIV positive. Lamivudine was a probable cause of PRCA in 18.5% of cases, although the true causal relationship was uncertain. Corticosteroids and IVIG were first-line therapy in 44.4% (n=12) and 37.0% (n=10) of cases, respectively. Thirteen patients (48.2%) achieved a complete response and 7 (25.9%) a partial response, while 2 (7.4%) showed no response, with continued transfusion dependence.Conclusion. In this population, women were disproportionately affected by PRCA. HIV was the single most important cause of acquired PRCA, which was independent of virological control. Parvovirus B19 and drugs were also important causes of acquired PRCA and played a critical part in the evaluation and work-up of PRCA. Nearly half of the patients achieved a complete response to therapy, which was sustained over 24 months.
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Diagnostic accuracy of the American College of Rheumatology-1997, the Systemic Lupus International Collaborating Clinics-2012, and the European League Against Rheumatism-2019 criteria for juvenile systemic lupus erythematosus: A systematic review and network meta-analysis. Clin Exp Rheumatol 2022; 21:103144. [PMID: 35842200 DOI: 10.1016/j.autrev.2022.103144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022]
Abstract
IMPORTANCE/BACKGROUND Several diagnostic criteria have been developed to effectively diagnose systemic lupus erythematosus (SLE). Three criteria are most common, namely the American College of Rheumatology (ACR)-1997, the Systemic Lupus International Collaborating Clinics (SLICC)-2012, and the European League Against Rheumatism (EULAR/ACR)-2019. Whether they also apply to juvenile SLE is unclear. OBJECTIVE To examine the diagnostic accuracy of ACR-1997, SLICC-2012, and EULAR/ACR-2019 for juvenile SLE. DATA SOURCES A comprehensive search of PubMed, Cochrane, and Embase was conducted up to 26 March 2022. STUDY SELECTION We included all study designs in which patients had any index tests for ACR-1997, SLICC-2012, or EULAR/ACR-2019; both full-text papers and conference abstracts published in English were used. Exclusion criteria were as follows: (1) case reports; (2) adult subjects; or (3) did not report sufficient information to acquire true positive, false positive, true negative, and false negative values of diagnostic criteria. DATA EXTRACTION AND SYNTHESIS Two authors independently screened studies, extracted relevant data, and assessed the risk of bias. MAIN OUTCOMES AND MEASURES First, a meta-analysis of the diagnostic accuracy of EULAR/ACR-2019 and a hierarchical summary receiver operating characteristic (HSROC) model was performed to estimate sensitivity and specificity with 95% confidence intervals (CIs). We then carried out a network meta-analysis to compare the performances of these three diagnostic criteria. RESULTS In total, 17 relevant studies that included 2339 juvenile SLE patients were eligible to analyze pooled accuracy. In the meta-analysis, 10 studies (1613 cases) reported the diagnostic performance of EULAR/ACR-2019, showing a pooled sensitivity of 0.92 (95% CI, 0.89-0.95), pooled specificity of 0.89 (0.77-0.95), and area under HSROC of 0.96 (0.94-0.97). In the network meta-analysis, the SLICC-2012 (0.94, 0.92-0.96) had the highest sensitivity, followed by EULAR/ACR-2019 (0.93, 0.90-0.95), and ACR-1997 (0.78, 0.72-0.82); the ACR-1997 (0.96, 0.92-0.98) demonstrated the highest specificity. EULAR/ACR-2019 (0.92, 0.87-0.96) and SLICC-2012 (0.92, 0.86-0.96) had the similar specificity. CONCLUSIONS AND RELEVANCE We found that the applicability of the new EULAR/ACR-2019 criteria in juvenile SLE is not yet the best diagnostic tool. TRIAL REGISTRATION PROSPERO CRD42022321514.
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Lee MH, Koh JWH, Ng CH, Lim SHH, Cho J, Lateef A, Mak A, Tay SH. A meta-analysis of clinical manifestations in asian systemic lupus erythematous: The effects of ancestry, ethnicity and gender. Semin Arthritis Rheum 2021; 52:151932. [PMID: 34996626 DOI: 10.1016/j.semarthrit.2021.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) in Asians is a unique patient group that has been thought to present with more severe organ involvement in comparison to their non-Asian counterparts. We set out to perform a meta-analysis to compare clinical manifestations between ancestries, with a focus on Southeast Asian ethnicities and gender. MATERIALS AND METHODS A cross-sectional study was performed in conjunction with a meta-analysis to identify differences in prevalences of SLE clinical manifestations. Searches were conducted on Medline for articles comparing between: (i) Asian and non-Asian ancestry; (ii) Southeast Asian ethnicities (Chinese, Malay and Indian); and (iii) male and female Asians. Using random effects model, effect sizes as odd ratios were pooled with DerSimonian and Laird's model. RESULTS A total of 13 articles were identified and pooled together with our study for this meta-analysis. Comparing among patients of Asian with Non-Asian/European ancestries, no significance difference was found in severe organ manifestations such as renal and neurological involvement [odds ratio (OR): 1.398, p= 0.320 and OR: 1.224, p= 0.526 respectively]. There was significantly greater proportion of Asian SLE patients with thrombocytopenia compared to non-Asian SLE. Chinese SLE patients were less likely to have oral ulcers compared to Indian SLE patients. Lastly, Asian male SLE patients had greater incidence of renal involvement and thrombocytopenia compared to Asian female SLE patients. CONCLUSIONS Severe SLE manifestations such as renal and neurological involvement were not significantly more frequent in Asian SLE compared to non-Asian/European SLE in this analysis.
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Affiliation(s)
- Ming Hui Lee
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Jeffery Wei Heng Koh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sandy H H Lim
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Jiacai Cho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Aisha Lateef
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Woodlands Health Campus, Singapore
| | - Anselm Mak
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Sen Hee Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore.
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Takei S, Igarashi T, Kubota T, Tanaka E, Yamaguchi K, Yamazaki K, Itoh Y, Arai S, Okamoto K, Mori M. Clinical practice guidance for childhood-onset systemic lupus erythematosus-secondary publication. Mod Rheumatol 2021; 32:239-247. [PMID: 34910196 DOI: 10.1093/mr/roab002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 11/12/2022]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) has been recognised as a more acute and severe autoimmune disease than adult-onset SLE. With the development of medications for the disease and supportive therapy, the mortality rate associated with cSLE has drastically improved; the 10-year survival rate among patients with cSLE between 1995 and 2006 in Japan was 98.3%. However, the 10-year survival rate without any permanent functional impairment remained low at 66.1%. Therefore, the current treatment goal for cSLE is to ensure that they can perform normal daily activities throughout their lives by preventing the occurrence and/or progression of organ damage. For this purpose, appropriate treatments and evaluations are required according to the severity and risk of organ damage; however, there are no established guidelines for cSLE. Therefore, the Pediatric Rheumatology Association of Japan and the Pediatric Rheumatology Subcommittee in the Japan College of Rheumatology developed a comprehensive guidance for clinical practice based on cSLE-related data collected from Japanese national surveys and relevant articles from both domestic and international sources. However, due to the lack of indications for defined and objective evidence quality levels, this guidance should be used on the basis of the judgement of the attending physicians for individual patients.
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Affiliation(s)
- Syuji Takei
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Toru Igarashi
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Tomohiro Kubota
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Eriko Tanaka
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Kenichi Yamaguchi
- Immune Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuko Yamazaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuhiko Itoh
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital, Tokyo, Japan
| | - Keisuke Okamoto
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Ogata Y, Fujieda Y, Sugawara M, Sato T, Ohnishi N, Kono M, Kato M, Oku K, Amengual O, Atsumi T. Morbidity and mortality in antiphospholipid syndrome based on cluster analysis: a 10-year longitudinal cohort study. Rheumatology (Oxford) 2021; 60:1331-1337. [PMID: 32944779 DOI: 10.1093/rheumatology/keaa542] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/16/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Using cluster analysis, to identify the subgroup of patients with APS with the poorest prognosis and clarify the characteristics of that subgroup. METHODS This is a longitudinal retrospective cohort study of APS patients. Using clinical data and the profile of aPL, cluster analysis was performed to classify the patients into subgroups. Events were defined as thrombosis, severe bleeding, and mortality. RESULTS A total of 168 patients with APS were included. Cluster analysis classified the patients into three subgroups; Cluster A (n = 61): secondary APS, Cluster B (n = 56): accumulation of cardiovascular risks and arterial thrombosis, Cluster C (n = 61): triple positivity of aPL and venous thrombosis. Cluster B showed significantly higher frequency of the events and higher mortality compared with the other clusters (P = 0.0112 for B vs A and P = 0.0471 for B vs C). CONCLUSION Using cluster analysis, we clarified the characteristics of the APS patients with the poorest prognosis. Risk factors for cardiovascular disease may further increase events in patients with APS.
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Affiliation(s)
- Yusuke Ogata
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuichiro Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masanari Sugawara
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Taiki Sato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoki Ohnishi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Michihito Kono
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Olga Amengual
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Jin H, Huang T, Wu R, Zhao M, Wu H, Long H, Yin H, Liao J, Luo S, Liu Y, Zhang Q, Zhang P, Tan Y, Luo S, Huang X, Deng Y, Liao W, Duan L, Chen J, Zhou Y, Yin J, Qiu H, Yuan J, Wang Z, Li M, Wu X, Chen L, Cai L, Huang C, Li Q, Tang B, Yu B, Li X, Gao X, Hu Y, Ren X, Xue H, Wei Z, Chen J, Li F, Ling G, Luo H, Zhao H, Yang S, Cui Y, Lin Y, Yao X, Sun L, Guo Q, Fang H, Zeng K, Deng D, Zhang J, Li Y, Pu X, Liao X, Dang X, Huang D, Liang Y, Sun Q, Xie H, Zeng L, Huang C, Diao Q, Tao J, Yu J, Li Z, Xu H, Li H, Lai W, Liu X, Wu J, Li T, Lei T, Sun Q, Li Y, Zhang G, Huang X, Lu Q. A comparison and review of three sets of classification criteria for systemic lupus erythematosus for distinguishing systemic lupus erythematosus from pure mucocutaneous manifestations in the lupus disease spectrum. Lupus 2020; 29:1854-1865. [PMID: 33028176 DOI: 10.1177/0961203320959716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although the original purpose of the systemic lupus erythematosus (SLE) classification criteria was to distinguish SLE from other mimic diseases, and to facilitate sample selection in scientific research, they have become widely used as diagnostic criteria in clinical situations. It is not known yet if regarding classification criteria as diagnostic criteria, what problems might be encountered? This is the first study comparing the three sets of classification criteria for SLE, the 1997 American College of Rheumatology (ACR’97), 2012 Systemic Lupus International Collaborating Clinics (SLICC’12) and 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR’19), for their ability to distinguish patients with SLE from patients with pure mucocutaneous manifestations (isolated cutaneous lupus erythematosus without internal disease, i-CLE) in the lupus disease spectrum. 1,865 patients with SLE and 232 patients with i-CLE were recruited from a multicenter study. We found that, due to low specificity, none of the three criteria are adept at distinguishing patients with SLE from patients with i-CLE. SLICC’12 performed best among the original three criteria, but if a positive ANA was removed as an entry criterion, EULAR/ACR’19 would performed better. A review of previous studies that compared the three sets of criteria was presented in this work.
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Affiliation(s)
- Hui Jin
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Tao Huang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Ruifang Wu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Ming Zhao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Haijing Wu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Hai Long
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Heng Yin
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Jieyue Liao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Shuangyan Luo
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Yu Liu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Qing Zhang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Peng Zhang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Yixin Tan
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Shuaihantian Luo
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Xin Huang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Yaxiong Deng
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Wei Liao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Liu Duan
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Jianbo Chen
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Yin Zhou
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
- Department of Medical CosmetoIogy, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Jinghua Yin
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Hong Qiu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Jin Yuan
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Zijun Wang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Mengying Li
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Xiaoqi Wu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Lina Chen
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Liangmin Cai
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Cancan Huang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Qianwen Li
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Bingsi Tang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Bihui Yu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Xin Li
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Xiaofei Gao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Yixi Hu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Xiaolei Ren
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Haofan Xue
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Zhangming Wei
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Jinwei Chen
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fen Li
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guanghui Ling
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hui Luo
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China
| | - Hongjun Zhao
- Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha, China
| | - Sen Yang
- Department of Dermatology, Institute of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Yong Cui
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Youkun Lin
- Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xu Yao
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Lingyun Sun
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Qing Guo
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Kang Zeng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Danqi Deng
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Yuzhen Li
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiongming Pu
- Department of Dermatology, The People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, China
| | - Xiangping Liao
- Department of nephropathy and Rheumatology, The First People's Hospital of ChenZhou, ChenZhou, China
| | - Xiqiang Dang
- Laboratory of Children's Kidney Disease, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Danlin Huang
- Laboratory of Children's Kidney Disease, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yumei Liang
- Department of Nephropathy and Rheumatology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Qing Sun
- Department of Dermatology, Qilu Hospital of Shandong University, Jinan, China
| | - Hongju Xie
- Department of Medical cosmetology, First Affiliated Hospital, University of South China, Hengyang, China
| | - Li Zeng
- Department of Medical cosmetology, First Affiliated Hospital, University of South China, Hengyang, China
| | - Cibo Huang
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Qingchun Diao
- Department of Dermatology, Chongqing Traditional Chinese Medicine Hospital, Chongqing First People's Hospital, Chongqing, China
| | - Juan Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Jianbin Yu
- Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhenlu Li
- Department of Dermatology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China
| | - Hanshi Xu
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui Li
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Lai
- Department of Dermatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiguang Liu
- Department of Dermatology, Heilongjiang Provincial Hospital, Harbin, China
| | - Jingjing Wu
- Department of Dermatology, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China
| | - Tienan Li
- Department of Dermatology, the Seventh People's Hospital of Shenyang, Shenyang, China
| | - Tiechi Lei
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qiuning Sun
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanjia Li
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guoqiang Zhang
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xin Huang
- Department of epidemiology, Medical School of Hunan Normal University, Changsha, China
| | - Qianjin Lu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Key Technologies of Immune-Related Skin Diseases Diagnosis and Treatment, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
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9
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Johnson SR, Brinks R, Costenbader KH, Daikh D, Mosca M, Ramsey-Goldman R, Smolen JS, Wofsy D, Boumpas DT, Kamen DL, Jayne D, Cervera R, Costedoat-Chalumeau N, Diamond B, Gladman DD, Hahn B, Hiepe F, Jacobsen S, Khanna D, Lerstrøm K, Massarotti E, McCune J, Ruiz-Irastorza G, Sanchez-Guerrero J, Schneider M, Urowitz M, Bertsias G, Hoyer BF, Leuchten N, Tani C, Tedeschi SK, Touma Z, Schmajuk G, Anic B, Assan F, Chan TM, Clarke AE, Crow MK, Czirják L, Doria A, Graninger WB, Halda-Kiss B, Hasni S, Izmirly PM, Jung M, Kumánovics G, Mariette X, Padjen I, Pego-Reigosa JM, Romero-Diaz J, Rúa-Figueroa Í, Seror R, Stummvoll GH, Tanaka Y, Tektonidou MG, Vasconcelos C, Vital EM, Wallace DJ, Yavuz S, Meroni PL, Fritzler MJ, Naden R, Dörner T, Aringer M. Performance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities. Ann Rheum Dis 2020; 79:1333-1339. [PMID: 32816709 DOI: 10.1136/annrheumdis-2020-217162] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 Classification Criteria for systemic lupus erythematosus (SLE) have been validated with high sensitivity and specificity. We evaluated the performance of the new criteria with regard to disease duration, sex and race/ethnicity, and compared its performance against the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and ACR 1982/1997 criteria. METHODS Twenty-one SLE centres from 16 countries submitted SLE cases and mimicking controls to form the validation cohort. The sensitivity and specificity of the EULAR/ACR 2019, SLICC 2012 and ACR 1982/1997 criteria were evaluated. RESULTS The cohort consisted of female (n=1098), male (n=172), Asian (n=118), black (n=68), Hispanic (n=124) and white (n=941) patients; with an SLE duration of 1 to <3 years (n=196) and ≥5 years (n=879). Among patients with 1 to <3 years disease duration, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 81%). The EULAR/ACR criteria performed well in men (sensitivity 93%, specificity 96%) and women (sensitivity 97%, specificity 94%). Among women, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 83%) and better specificity than the SLICC criteria (94% vs 82%). Among white patients, the EULAR/ACR criteria had better sensitivity than the ACR criteria (95% vs 83%) and better specificity than the SLICC criteria (94% vs 83%). The EULAR/ACR criteria performed well among black patients (sensitivity of 98%, specificity 100%), and had better sensitivity than the ACR criteria among Hispanic patients (100% vs 86%) and Asian patients (97% vs 77%). CONCLUSIONS The EULAR/ACR 2019 criteria perform well among patients with early disease, men, women, white, black, Hispanic and Asian patients. These criteria have superior sensitivity than the ACR criteria and/or superior specificity than the SLICC criteria across many subgroups.
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Affiliation(s)
- Sindhu R Johnson
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital; Institute of Health Policy, Management and Evaulation, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Brinks
- Policlinic and Hiller Research Unit of Rheumatology, Heinrich-Heine-University Duesseldorf, Düsseldorf, Germany
| | - Karen H Costenbader
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Rheumatology, Harvard Medical School, Boston, Massachusetts, USA
| | - David Daikh
- Medicine/Rheumatology, UCSF Medical Center, San Francisco, California, USA
| | - Marta Mosca
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Rosalind Ramsey-Goldman
- Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Josef S Smolen
- Rheumatology, Medical University of Vienna, Vienna, Austria
| | - David Wofsy
- Division of Rheumatology, , Russell/Engleman Rheumatology Research Center, University of California, San Francisco, San Francisco, California, USA
| | - Dimitrios T Boumpas
- Medicine, National and Kapodestrian University of Athens, and Biomedical Research Foundation of the Athens Academy, Athens, Greece.,Rheumatology, University of Cyprus Medical School, Nicosia, Nicosia, Cyprus
| | - Diane L Kamen
- Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Jayne
- Medicine, University of Cambridge, Cambridge, UK
| | - R Cervera
- Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Nathalie Costedoat-Chalumeau
- Internal Medicine, Hospital Cochin, Paris, Île-de-France, France.,INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Betty Diamond
- Autoimmune and Musculoskeletal, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Dafna D Gladman
- Medicine, University of Toronto, Toronto, Ontario, Canada.,Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Bevra Hahn
- Rheumatology, UCLA School of Medicine, Los Angeles, California, USA
| | - Falk Hiepe
- Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Søren Jacobsen
- Department of Rheumatology, Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Elena Massarotti
- Rheumatology, Harvard Medical School, Boston, Massachusetts, USA.,Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph McCune
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Unit, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | - Jorge Sanchez-Guerrero
- Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.,Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico
| | - Matthias Schneider
- Policlinic and Hiller Research Unit for Rheumatology, Medical Faculty,Heinrich-Heine-University, Düsseldorf, Germany
| | - Murray Urowitz
- Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - George Bertsias
- Rheumatology, University of Crete School of Medicine, Iraklio, Crete, Greece.,Laboratory of Autoimmunity-Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Crete, Greece
| | - Bimba F Hoyer
- Rheumatology and Clinical Immunology, University of Schleswig-Holstein at Kiel, Kiel, Germany
| | - Nicolai Leuchten
- Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Chiara Tani
- Rheumatology, Azienda Ospedaliero Universitaria Pisana, Pisa, Toscana, Italy.,Rheumatology, University of Pisa, Pisa, Toscana, Italy
| | - Sara K Tedeschi
- Rheumatology, Harvard Medical School, Boston, Massachusetts, USA.,Medicine, Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zahi Touma
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gabriela Schmajuk
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
| | - Branimir Anic
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Florence Assan
- INSERM UMR 1163, Université Paris Sud, Hôpitaux Universitaires Paris-Sud, AP-HP, INSERM UMR 1184, Paris, France
| | - Tak Mao Chan
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Ann Elaine Clarke
- Rheumatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mary K Crow
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, New York, New York, USA
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Andrea Doria
- Division of Rheumatology, University of Padova, Padova, Italy
| | | | | | - Sarfaraz Hasni
- Rheumatology, NIAMS, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter M Izmirly
- Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Michelle Jung
- Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Gábor Kumánovics
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Xavier Mariette
- Hôpitaux Universitaires Paris-Sud, AP-HP, INSERM UMR, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Ivan Padjen
- Division of Clinical Immunology and Rheumatology, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Zagreb, Croatia
| | - José M Pego-Reigosa
- Rheumatology, University Hospital of Vigo, IRIDIS Group, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
| | - Juanita Romero-Diaz
- Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
| | - Íñigo Rúa-Figueroa
- Rheumatology, Dr Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Raphaèle Seror
- INSERM UMR 1163, Université Paris Sud, Hôpitaux Universitaires Paris-Sud, AP-HP, INSERM UMR 1184, Paris, France
| | | | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Maria G Tektonidou
- Medical School, National and Kapodistrian University of Athens, Athinon, Greece
| | | | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D J Wallace
- Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sule Yavuz
- Rheumatology, Istanbul Bilim Universitesi, Istanbul, Turkey
| | - Pier Luigi Meroni
- Clinical Immunology and Rheumatology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Marvin J Fritzler
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ray Naden
- Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Thomas Dörner
- Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Aringer
- Rheumatology, University Medical Center and Faculty of Medicine Carl Gustav Carus, Dresden, Germany
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10
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Bakula M, Čikeš N, Anić B. Validation of the new classification criteria for systemic lupus erythematosus on a patient cohort from a national referral center: a retrospective study. Croat Med J 2019. [PMID: 31483119 PMCID: PMC6734577 DOI: 10.3325/croatmedj_60_0325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM To validate Systemic Lupus International Collaborating Clinics (SLICC)-12 and American College of Rheumatology (ACR)-97 classification criteria on a patient cohort from the University Hospital Center Zagreb. METHODS This retrospective study, conducted from 2014 to 2016, involved 308 patients with systemic lupus erythematosus (SLE) (n=146) and SLE-allied conditions (n=162). Patients' medical charts were evaluated by an expert rheumatologist to confirm the clinical diagnosis, regardless of the number of the ACR-97 criteria met. Overall sensitivity and specificity, as well as the sensitivity and specificity according to disease duration, were compared between ACR-97 and SLICC-12 classifications. Predictive value for SLE for both classifications was assessed using logistic regression and receiver operating characteristic (ROC) curves. RESULTS The SLICC-12 criteria had significantly higher sensitivity in early disase, which increased with disease duration. The ACR-97 criteria had higher specificity. The specificity of the SLICC-12 criteria was low and decreased with disease duration. Regression analysis demonstrated the superiority of the SLICC-12 classification criteria over the ACR-97 criteria, with areas under the ROC curve of 0.801 and 0.780, respectively. CONCLUSION Although the SLICC-12 criteria were superior to the ACR-97 and were more sensitive for diagnosing early SLE, their specificity in our population was too low. The sensitivity of the SLICC-12 classification is increased by better defined clinical features within each criterion. Our results contribute to the current initiative for developing new criteria for SLE.
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Affiliation(s)
- Marija Bakula
- Marija Bakula, Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb School of Medicine, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia,
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11
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Adamichou C, Nikolopoulos D, Genitsaridi I, Bortoluzzi A, Fanouriakis A, Papastefanakis E, Kalogiannaki E, Gergianaki I, Sidiropoulos P, Boumpas DT, Bertsias GK. In an early SLE cohort the ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria classify non-overlapping groups of patients: use of all three criteria ensures optimal capture for clinical studies while their modification earlier classification and treatment. Ann Rheum Dis 2019; 79:232-241. [PMID: 31704720 DOI: 10.1136/annrheumdis-2019-216155] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Classification criteria are biased towards classifying long-standing disease. We compared the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR)-2019, Systemic Lupus International Collaborating Clinics (SLICC)-2012 and ACR-1997 criteria in an early (median 48 months) systemic lupus erythematosus (SLE) cohort. METHODS Patients diagnosed with SLE (n=690) or control diseases (n=401). Sensitivity, specificity of the criteria and time-to-classification were calculated. Modified classification algorithms were derived from a random 80% and validated in the remaining 20% of the dataset running multiple iterations. RESULTS At last assessment, sensitivities of ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria were 85.7%, 91.3% and 88.6%, with specificities 93.0%, 93.8% and 97.3%, respectively. Both SLICC and EULAR/ACR enabled earlier classification. Only 76.7% of patients with SLE met all three criteria suggesting non-overlapping groups. Notably, unclassified patients had high prevalence of British Isles Lupus Assessment Group moderate/severe manifestations (43.3%-60%) and SLICC/ACR organ damage (30%-50%). At diagnosis, criteria missed 25.6%-30.5% of patients. Modification of EULAR/ACR and SLICC algorithms to include hypocomplementaemia and/or positive anti-phospholipid antibodies as alternative entry criterion, and/or allow classification with fewer clinical criteria from multiple organs, increased their sensitivity at diagnosis (median 82.0% and 86.2%) and overall (93.7% and 97.1%) with modest decreases in specificity. Importantly, patients who were still missed by the modified criteria had lower incidence of major organ involvement, use of immunosuppressive/biological therapies and organ damage. CONCLUSIONS The SLICC and EULAR/ACR are more sensitive than the ACR and the EULAR/ACR criteria have superior specificity in early SLE, although patients with significant disease can be missed. Combination and/or modification of the classification algorithms may enhance their sensitivity, allowing earlier classification and treatment of more patients with high disease burden.
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Affiliation(s)
- Christina Adamichou
- Department of Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Greece
| | - Dionysis Nikolopoulos
- 4th Department of Medicine, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Irini Genitsaridi
- Foundation for Research and Technology Hellas, Institute of Computer Science, Heraklion, Greece
| | - Alessandra Bortoluzzi
- Section of Rheumatology Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera - Universitaria Sant'Anna, Cona (Ferrara), Italy
| | - Antonis Fanouriakis
- 4th Department of Medicine, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmanouil Papastefanakis
- Department of Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Greece
| | - Eleni Kalogiannaki
- Department of Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Greece
| | - Irini Gergianaki
- Department of Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Greece
| | - Prodromos Sidiropoulos
- Department of Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Greece.,Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology - Hellas (FORTH), Iraklio, Greece
| | - Dimitrios T Boumpas
- 4th Department of Medicine, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
| | - George K Bertsias
- Department of Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Greece .,Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology - Hellas (FORTH), Iraklio, Greece
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12
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Rodrigues Fonseca A, Felix Rodrigues MC, Sztajnbok FR, Gerardin Poirot Land M, Knupp Feitosa de Oliveira S. Comparison among ACR1997, SLICC and the new EULAR/ACR classification criteria in childhood-onset systemic lupus erythematosus. Adv Rheumatol 2019; 59:20. [PMID: 31092290 DOI: 10.1186/s42358-019-0062-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/01/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To date there are no specific classification criteria for childhood-onset systemic lupus erythematosus (cSLE). This study aims to compare the performance among the American College of Rheumatology (ACR) 1997, the Systemic Lupus International Collaborating Clinics criteria (SLICC) and the new European League Against Rheumatism (EULAR)/ACR criteria, in a cSLE cohort. METHODS We conducted a medical chart review study of cSLE cases and controls with defined rheumatic diseases, both ANA positive, to establish each ACR1997, SLICC and EULAR/ACR criterion fulfilled, at first visit and 1-year-follow-up. RESULTS Study population included 122 cSLE cases and 89 controls. At first visit, SLICC criteria had higher sensitivity than ACR 1997 (89.3% versus 70.5%, p < 0.001), but similar specificity (80.9% versus 83.2%, p = 0.791), however performance was not statistically different at 1-year-follow-up. SLICC better scored in specificity compared to EULAR/ACR score ≥ 10 at first visit (80.9% versus 67.4%, p = 0.008) and at 1-year (76.4% versus 58.4%, p = 0.001), although sensitivities were similar. EULAR/ACR criteria score ≥ 10 exhibited higher sensitivity than ACR 1997 (87.7% versus 70.5%, p < 0.001) at first visit, but comparable at 1-year, whereas specificity was lower at first visit (67.4% versus 83.2%, p = 0.004) and 1-year (58.4% versus 76.4%, p = 0.002). A EULAR/ACR score ≥ 13 against a score ≥ 10, resulted in higher specificity, positive predictive value, and cut-off point accuracy. Compared to SLICC, a EULAR/ACR score ≥ 13 resulted in lower sensitivity at first visit (76.2% versus 89.3%, p < 0.001) and 1-year (91% versus 97.5%, p = 0.008), but similar specificities at both assessments. When compared to ACR 1997, a EULAR/ACR total score ≥ 13, resulted in no differences in sensitivity and specificity at both observation periods. CONCLUSIONS In this cSLE population, SLICC criteria better scored at first visit and 1-year-follow-up. The adoption of a EULAR/ACR total score ≥ 13 in this study, against the initially proposed ≥10 score, was most appropriate to classify cSLE. Further studies are necessary to address if SLICC criteria might allow fulfillment of cSLE classification earlier in disease course and may be more inclusive of cSLE subjects for clinical studies.
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Affiliation(s)
- Adriana Rodrigues Fonseca
- Pediatric Rheumatology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50-Cidade Universitária, Rio de Janeiro, Brazil.
| | - Marta Cristine Felix Rodrigues
- Pediatric Rheumatology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50-Cidade Universitária, Rio de Janeiro, Brazil
| | - Flavio Roberto Sztajnbok
- Pediatric Rheumatology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50-Cidade Universitária, Rio de Janeiro, Brazil
| | - Marcelo Gerardin Poirot Land
- Internal Medicine Post-graduation Program, Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Sheila Knupp Feitosa de Oliveira
- Pediatric Rheumatology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50-Cidade Universitária, Rio de Janeiro, Brazil
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Abstract
RATIONALE Systemic lupus erythematosus (SLE) is a connective tissue disease that has many clinical manifestations. However, cardiac tamponade has been rarely reported especially as an initial presenting feature of systemic lupus erythematosus. Herein, we describe a case of cardiac tamponade as the first presentation of systemic lupus erythematosus in a male and presented the course of diagnosis and treatment of this patient. PATIENT CONCERNS A 32-year-old male patient developed a rapid progression of pericardial effusion and he was almost healthy in the past. Vital signs were significantly marked by high fever, tachycardia, and accelerated breathing rate of 37 times per minute. The ANA titer was 1:320 and anti-dsDNA was positive during his hospitalization. The complement levels were decreased but the ESR and the CRP level were increased obviously. Soon after, he appeared anemic and thrombocytopenic. DIAGNOSES The diagnosis of SLE was made based on the clinical and biochemical findings according to 2012 SLICC SLE Criteria. INTERVENTIONS The interventions included use CT-guided pericardial puncture to relieve symptoms in time; utilize high-dose glucocorticoids and immunosuppressants to therapy SLE; closely monitor the vital signs, blood routine, blood biochemical indicators, and volume of pericardial effusion. OUTCOMES After 2 months, the symptoms were disappeared almost completely and TTE showed his pericardial effusion had decreased significantly. LESSONS We should also keep SLE in mind when assessing male patients with pericardial effusions. Early examinations of sero-immunological markers and closely monitoring the performances are important for the diagnosis of the disease. Early pericardial puncture can quickly relieve symptoms and improve prognosis.
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Dai ZW, Wang H, Xu WJ, Wang ZH, Xu SQ, Wang B, Ye DQ. Diagnostic accuracy of miRNAs as potential biomarkers for systemic lupus erythematosus: a meta-analysis. Clin Rheumatol 2018; 37:2999-3007. [PMID: 29980876 DOI: 10.1007/s10067-018-4189-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/30/2018] [Accepted: 06/24/2018] [Indexed: 02/01/2023]
Abstract
To systematically evaluate the diagnostic accuracy of miRNAs as potential biomarkers for systemic lupus erythematosus (SLE). Studies were searched in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and China Biology Medicine (CBM) disc database, and languages were limited in English and Chinese. QUADAS-2 tool was applied to assess the quality of eligible studies. Random-effect model was applied to calculate pooled effects of miRNAs on diagnosing SLE. Subgroup analysis was used to explore the sources of heterogeneity. All data were calculated and analyzed by Meta-Disc 1.4 and RevMan 5.3 software. Six eligible studies were included in this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio of miRNAs were 0.75(95% CI 0.71-0.79), 0.72(95% CI 0.66-0.78), and 8.79(95% CI 4.91-15.73), respectively. The pooled positive likelihood ratio was 2.71(95% CI 2.20-3.33) and negative likelihood ratio was 0.34(95% CI 0.24-0.48). The area under the curve was 0.787. The subgroup analysis showed that the number of healthy controls might be the sources of heterogeneity. MiRNAs in blood have moderate accuracy and influence on diagnosing SLE, and the exact diagnostic value should be confirmed by further studies.
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Affiliation(s)
- Zi-Wei Dai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui Province Key Laboratory of Major Autoimmune Diseases, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Hong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui Province Key Laboratory of Major Autoimmune Diseases, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Wen-Juan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui Province Key Laboratory of Major Autoimmune Diseases, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Zhi-Hui Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui Province Key Laboratory of Major Autoimmune Diseases, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Sheng-Qian Xu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, Anhui, China
| | - Bin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui Province Key Laboratory of Major Autoimmune Diseases, 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui Province Key Laboratory of Major Autoimmune Diseases, 81 Meishan Road, Hefei, 230032, Anhui, China.
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