International criteria catalogue for Lupus takes shape

New SLE classification criteria intend to help patients with SLE to be recognized more quickly and to be treated more effectively.

The goal is to detect and treat SLE faster

Sometimes, rashes announce systemic lupus erythematosus (SLE), but for other patients, joint pain is the first symptom. Even seemingly groundless fever can indicate inflammatory autoimmune diseases, which mostly affects women in reproductive age. Due to the variety of symptoms, SLE is often diagnosed late. New SLE classification criteria intend to help patients with SLE to be recognized more quickly and to be treated more effectively.

"In SLE, autoantibodies cause inflammation in various organ systems," explained Professor Martin Aringer, Head of Rheumatology at the Technical University of Dresden’s University Hospital (Germany). The illness could, potentially, make itself noticeable everywhere in the body. However, skin and mucous membranes, joints, muscles, and kidneys are particularly frequently affected by inflammations, and more rarely, also the brain.

The reassessment should help to further reduce the number of errors

Antinuclear autoantibodies (ANA) in patients’ blood is considered the most important diagnostic screening test for SLE. However, these can also occur in healthy people, which is why further criteria must be met in order to classify the disease as SLE. Typical SLE symptoms include butterfly-like reddening of the face, hair loss, sores in the mouth or nose, fluid accumulation around the lungs or heart, protein in the urine (when kidneys are involved), or various blood count changes. However, these are only considered SLE symptoms if there is no obvious explanation. They are also weighted differently. "The reassessment for weighing these criteria should help to further reduce the number of errors," said Professor Aringer, who, together with Dr. Sindhu Johnson of the University of Toronto, played a leading role in the development of the new EULAR/ACR classification criteria.

Classification criteria are an essential basis for testing new drugs and advancing research into the disease. For this, it is important that they distinguish SLE patients as accurately as possible from patients with other diseases. The new criteria are mathematically even more precise than the previously used criteria from the American College of Rheumatology (ACR) and the Systemic Lupus International Collaborating Clinics (SLICC). In addition, the classification criteria for such rare and complex diseases as SLE shape the image physicians have of the disease. The authors, therefore, see it as a strength of the new criteria that they reflect the current diagnostic options as clear as possible - a task achieved with the worldwide participation of experts. The new SLE criteria are the first ever to bear the name of the EULAR (European League Against Rheumatism), the European umbrella organization of the national rheumatological societies.

A cure that remains even after discontinuation of the medication is generally not possible with SLE at present. "However, the goal must be to recognize SLE quickly and treat it in such a way that the disease activity disappears, hopefully causing relapses, not to occur. In this way, life-threatening situations and permanent damage can be avoided, and a mostly normal life remains possible," Aringer concluded. The new criteria could make a significant contribution to early detection.

Aringer M, Costenbader KH, Daikh DI, et al., 2019 EULAR/ACR Classification Criteria for Systemic Lupus Erythematosus. Ann Rheum Dis 2019; August 6 Epub and Arthritis Rheumatol 2019; August 6 Epub.