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PO.2.47 How small details affect the sensitivity of different SLE criteria? Investigating a large number of patients in a Hungarian center
  1. DL Csóka,
  2. K Tkovács,
  3. L Czirják and
  4. G Kumánovics
  1. University of Pécs, Medical School, Department of Rheumatology and Immunology ~ Pécs ~ Hungary


Introduction The new 2019 EULAR/ACR classification criteria includes compulsory ANA positivity as an entry criterion and contains 7 clinical and 3 immunologic domains. Each domain involves different clinical signs followed by weighted score from 2 to 10.

Aim To assess the performance of the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for SLE patients against the ACR 1997 and the SLICC 2012 criteria.

Method We performed a retrospective observational study between 2018.01.01. and 2021.04.27. from 382 patients with lupus. The diagnosis of SLE was established by the rheumatologist in rutine care and these diagnosis rates were compared against those that were determined based on the three classification criteria to identifying the sensitivities.

Results Among the patients the ACR 1997 sensitivity was 81% (310 patients) and the SLICC 2012 criteria achieved 95% sensitivity (361 patients). The 2019 EULAR/ACR classification criteria had a lower sensitivity (90% - 345 patients) than in the original publication (96%), because of the lower sensitivity of our ANA test: positive ANA was detected 94% of the patients tested by enzyme-linked immunosorbent assay (ELISA). Almost all ANA-negative (21/22, 95%) patients showed a positive lupus-associated antibody test: we established 17 patients with dsDNS, 2 patients with antiphospholipid, 1 patient with SSA and another one with C1q positivity. An addition of dsDNS test results to the ANA positivity as an entry criterion strengthened the sensitivity to 95% (362 patients). From the most important clinical manifestations only neurologic involvements showed higher prevalence investigated by SLICC criteria compared to 2019 EULAR/ACR criteria (78/361 patients (21,6%) vs. 29/345 patients (8,4%), p<0.001), and it was independent from the addition of dsDNS results to ANA positivity.

Conclusion All investigated criteria sensitivity were similar to the original publication’s findings, but in some patients our ANA ELISA test showed false negative results. In case of using another method like standard indirect immunofluorescent staining (on HEp-2 or Crithidia luciliae) we recommend a parallel investigation for dsDNS test and a preparatory analysis of the description of the available ANA test.

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