New SLE Classification Criteria Perform Well in Early Disease and Across Sexes, Ethnicities

Researchers evaluated the performance of 2019 EULAR/ACR classification criteria for systemic lupus erythematosus, with regard to disease duration, sex, and race/ethnicity.

The 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria perform well among patients with early systemic lupus erythematosus (SLE) and across sexes and ethnicities, according to study results published in the Annals of the Rheumatic Diseases. Compared to the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and ACR 1982/1997 criteria, the 2019 EULAR/ACR criteria showed better sensitivity for SLE across patient subgroups defined by disease duration, sex, and ethnicity.

Developed in 2019, the EULAR/ACR criteria were validated in a cohort of patients with SLE from 21 treatment centers in 16 countries. Each center submitted between 20 and 100 SLE cases and an equal number of SLE-mimicking control participants. Case and control diagnoses were made independently by 3 SLE experts using the EULAR/ACR 2019 criteria. Case and control diagnoses were then compared to the actual case status from each center. Sensitivity and specificity were computed for the EULAR/ACR 2019 guidelines. A similar procedure was conducted for the ACR 1982/1997 and SLICC 2012 criteria. Results were compared between the old and updated classification criteria.

The validation cohort included 1270 patients, among whom 1098 (86%) were women; 74% were White. The majority of patients had disease duration of ≥5 years (n=879; 69%). Among patients with 1 to <3 years disease duration (n=196; 16%), the EULAR/ACR criteria had superior sensitivity to the ACR criteria (97% vs 81%, respectively). Among women, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 83%, respectively) and better specificity than the SLICC criteria (94% vs 82%, respectively). The EULAR/ACR criteria also performed well among men, with the sensitivity outperforming that of the ACR 1982/1997 criteria (93% vs 78%, respectively). The EULAR/ACR criteria also had better sensitivity vs ACR 1982/1997 criteria among White (95% vs 83%), Hispanic (100% vs 86%, respectively), and Asian (97% vs 77%, respectively) patients. The EULAR/ACR criteria had high sensitivity (98%) and specificity (100%) among Black patients, though the small cohort size prevented comparisons with other classification criteria.  

These data support the diagnostic capacity of the updated EULAR/ACR classification criteria for SLE. The criteria was also found to be perform well among patients with early disease and populations typically under-represented in rheumatic disease research.

As study limitations, researchers noted that the cohort was primarily White; although EULAR/ACR criteria performed well among Black, Asian, and Hispanic participants, further study is necessary to validate these results.

“Overall, the new criteria provide added value compared with previous versions of SLE classification. The EULAR/ACR 2019 SLE criteria provide early and accurate classification of SLE across various patient subpopulations with SLE,” the researchers concluded.


Johnson SR, Brinks R, Costenbader KH, et al. Performance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities. Published online August 14, 2020. Ann Rheum Dis. doi:10.1136/annrheumdis-2020-217162