SOAP BRAIN MD.
I still hear trainees mention this whenever discussing criteria features of SLE (do you remember what it stands for?). The current 1997 American College of Rheumatology criteria is actually the third version of the most commonly used classification criteria (yes, it’s NOT diagnostic criteria). However, a new set of classification criteria is being introduced – a result of 8 years of incorporating new knowledge about lupus immunology. There are actually more things to remember and I have yet to come across a mnemonic for this. The Systemic Lupus International Collaborating Clinics (SLICC) Classification Criteria has 17 criteria (11 clinical and 6 immunologic). To satisfy, at least 4 criteria should be present with at least one being immunologic criteria.
How does the new criteria differ from the 1997 ACR Criteria?
- Malar rash and photosensitivity are now part of acute cutaneous lupus (therefore, only counts as 1). Other variants of acute cutaneous lupus include bullous type, TENS-like, maculopapular lupus rash.
- Similarly, discoid lupus is part of chronic cutaneous lupus. And other variants such as verrucous, tumidus and chillblains may also qualify.
- Alopecia makes a comeback (it was actually part of the 1971 ARA Criteria which was dropped in 1982 ACR Criteria)
- Arthritis features are now defined as swelling or tenderness (synovitis) of at least 2 joints WITH morning stiffness >30 mins.
- Neurologic criteria has been expanded. Aside from seizures and psychosis, other known NPSLE manifestations have already been included – mononeuritis multiplex, myelitis, neuropathy, and acute confusional state.
- Hematologic criteria have been broken down to three (hemolytic anemia, leukopenia/ lymphopenia and thrombocytopenia) and still retaining the same cut-off values. Unlike before where all three criteria only counted as one.
- Immunologic criteria have been expanded to include low complement levels (C3, C4, CH50) and other forms of anti-phospholipid antibodies (lupus anticoagulant, anticardiolipin and anti-B2 glycoprotein I)
- A positive direct Coomb’s test is considered an immunologic criteria
- Presence of anti-dsDNA and anti-Sm are now separate criteria
The current SLICC Criteria is more sensitive (97% vs 83%) but less specific (84% vs 96%) than 1997 criteria. Applying both to a cohort of patients, there were fewer patients being misclassified as having SLE using the SLICC Criteria.