Lesser Damage Accrual Among Patients Not Fulfilling the 2019 EULAR/ACR Criteria for SLE

Patients who do not achieve the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria for the classification of systemic lupus erythematosus (SLE) accrue less damage and have a better prognosis, according to the results of a report published in Arthritis Care & Research.¹

Using patient data from the Lupus in Minorities: Nature vs Nurture (LUMINA) cohort, the investigators aimed to evaluate the performance of the 2019 EULAR/ACR criteria for the classification of patients with SLE in a multiethnic population.

In previous studies, the LUMINA cohort has been described and SLE defined using the 1982/1997 ACR classification criteria.² In this report, the investigators compared outcomes of patients who did and did not achieve the 2019 EULAR/ACR criteria. Predefined outcomes included SLE International Collaborating Clinics (SLICC)/ACR damage index (SDI) and survival at last visit.

Of the 640 patients included in the analysis, 98 did not achieve the 2019 EULAR/ACR criteria. Compared with patients who met the 2019 EULAR/ACR criteria, those who did not meet the criteria tended to be older and less likely to be Hispanic or black (P <.0001).

There was no difference in mean baseline SDI between patients who did and did not achieve the 2019 criteria (0.8 vs 0.6; P =.3580); however, the mean SDI at last visit was significantly lower for patients who did not achieve criteria vs those who did (1.2 vs 2.0; P =.0004). After adjusting for possible confounding factors, including age, sex, and race/ethnicity, the SDI score at last visit was 31% lower for those who did not achieve criteria compared with those who did (P =.0077).

Patients were divided into groups based on the duration of follow-up. In the group with ≥6 years of follow-up, patients who did not achieve the 2019 EULAR/ACR criteria accrued less damage than those who did (estimate, -0.96; P =.0205).

At the end of follow-up, there was no significant difference in the survival rates between patients who did and did not achieve criteria (84.1% vs 88.8%).

Study limitations included that fact that some variables in in the 2019 EULAR/ACR criteria were not collected in the LUMINA cohort, which may have affected results.

“The EULAR/ACR SLE classification criteria have been developed in order to improve the sensitivity and specificity of previous criteria,” the authors of this report concluded. “In our cohort, patients who did not achieve the 2019 EULAR/ACR criteria accrued less damage, suggesting that these criteria could allow us to identify a subset of patients with more severe disease than previous criteria.”

References

1. Ugarte-Gil MF, Pons-Estel GJ, Griffin R, Vilá LM, Reveille JD, Alarcón GS. Patients who do not fulfill the 2019 EULAR/ACR criteria for systemic lupus erythematosus accrue less damage [published online April 15, 2020]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24213

2. Alarcon GS, Friedman AW, Straaton KV, et al. Systemic lupus erythematosus in three ethnic groups: III. A comparison of characteristics early in the natural history of the LUMINA cohort. Lupus in Minority populations: Nature vs. Nurture. Lupus. 1999;8(3):197-209.