Wayne Robinson, MBBS Class of 2015
DIAGNOSTIC CRITERIA FOR SLE
Outline (need to know both by name and date!!)
1. Old: 1997 ACR revised criteria (Need 4 of 11)
2. New: 2012 SLICC SLE criteria (Need 4 of 17) [SLICC = Systemic Lupus International Collaborating Clinics]
2012 SLICC SLE Criteria
NB: For memory, there are 11 clinical and 6 Immunologic
And of the 11 clinical, 3 are dermatologic, 3 are haematologic (Hb, WBC, Plt), then the others
CLINICAL CRITERIA IN MORE DETAIL
(1) Acute Cutaneous Lupus OR Subacute Cutaneous Lupus
Acute cutaneous lupus: Lupus malar rash (do not count if malar discoid), bullous lupus, toxic epidermal
necrolysis variant of SLE, maculopapular lupus rash, photosensitive lupus rash (in the absence of
dermatomyositis)
Subacute cutaneous lupus: Nonindurated psoriaform and/or annular polycyclic lesions that resolve without scarring,
although occasionally with postinflammatory dyspigmentation or telangiectasias)
(2) Chronic Cutaneous Lupus
Classic discoid rash localized (above the neck) or generalized (above and below the neck), hypertrophic
(verrucous) lupus, lupus panniculitis (profundus), mucosal lupus, lupus erythematosus tumidus, chillblains
lupus, discoid lupus/lichen planus overlap
Wayne Robinson, MBBS Class of 2015
(3) Oral Ulcers OR Nasal Ulcers
Oral: palate, buccal, tongue
Nasal ulcers
In the absence of other causes!!, such as vasculitis, Behcets disease, infection (herpesvirus), inflammatory
bowel disease, reactive arthritis, and acidic foods
(4) Nonscarring alopecia
Diffuse thinning or hair fragility with visible broken hairs, in the absence of other causes such as alopecia
areata, drugs, iron deficiency, and androgenic alopecia
(5) Synovitis (arthritis) involving 2 or more joints
Characterized by swelling or effusion
OR tenderness in 2 or more joints and at least 30 minutes of morning stiffness
(6) Serositis
Pleural: Typical pleurisy for more than 1 day OR pleural effusions OR pleural rub
Pericardial: Typical pericardial pain (pain with recumbency improved by sitting forward) for more than 1 day
OR pericardial effusion OR pericardial rub OR pericarditis by electrocardiography
In the absence of other causes, such as infection, uremia, and Dresslers pericarditis
(7) Renal
Urine proteinto-creatinine ratio (or 24-hour urine protein) representing 500 mg protein/24 hours OR red blood
cell casts
(8) Neurologic
Seizures, psychosis, mononeuritis multiplex (in the absence of other known causes such as primary vasculitis),
myelitis, peripheral or cranial neuropathy (in the absence of other known causes such as primary vasculitis,
infection, and diabetes mellitus), acute confusional state (in the absence of other causes, including
toxic/metabolic, uremia, drugs)
(9) Haemolytic anemia
(10) Leucopaenia (<4000/mm3) OR Lymphopaenia (<1000/mm3)
Leucopenia at least once: In the absence of other known causes such as Feltys syndrome, drugs, and portal
hypertension.
Lymphopaenia at least once: in the absence of other known causes such as corticosteroids, drugs, and infection
(11) Thrombocytopenia (<100,000/mm3)
At least once in the absence of other known causes such as drugs, portal hypertension, and thrombotic
thrombocytopenic purpura
IMMUNOLOGIC CRITERIA
(1) ANA level above laboratory reference range
(2) Anti-dsDNA antibody level above laboratory reference range (or 2-fold the reference range if tested by ELISA)
(3) Anti-Sm: presence of antibody to Sm nuclear antigen
Wayne Robinson, MBBS Class of 2015
(4) Antiphospholipid antibody positivity, as determined by
Positive test for lupus anticoagulant
False-positive test result for rapid plasma reagin
Medium- or high-titer anticardiolipin antibody level (IgA, IgG, or IgM)
Positive test result for anti2-glycoprotein I (IgA, IgG, or IgM)
(5) Low complement (C3, C4, or CH50)
(6) Direct Coombs test (only counts as a point in the absence of haemolytic anemia)
American College of Rheumatology Criteria for Classification of Systemic Lupus
Erythematosus
1997 Update of the 1982 American College of Rheumatology revised criteria for classification of systemic
lupus erythematosus
More detailed:
The classification is based on 11 criteria. For the purpose of identifying patients in clinical studies, a person is defined as having SLE if any 4 or more of
the 11 criteria are present, serially or simultaneously, during any interval of observation.
[Link] Fixederythema,flatorraised,overthemalareminences,tendingtosparethenasolabialfolds
[Link] Erythematousraisedpatcheswithadherentkeratoticscalingandfollicularplugging;atrophicscarring
mayoccurinolderlesions
[Link] Skinrashasaresultofunusualreactiontosunlight,bypatienthistoryorphysicianobservation
[Link] Oralornasopharyngealulceration,usuallypainless,observedbyphysician
[Link] Involving2ormoreperipheraljoints,characterizedbytenderness,swelling,oreffusion
[Link]
1. Pleuritisconvincinghistoryofpleuriticpainorrubbingheardbyaphysicianorevidenceof
pleuraleffusion
OR
Wayne Robinson, MBBS Class of 2015
2. Pericarditisdocumentedbyelectrocardigramorruborevidenceofpericardialeffusion
[Link]
1. Persistentproteinuria>0.5gramsperdayor>than3+ifquantitationnotperformed
OR
2. Cellularcastsmayberedcell,hemoglobin,granular,tubular,ormixed
[Link]
1. Seizuresintheabsenceofoffendingdrugsorknownmetabolicderangements;e.g.,uremia,
ketoacidosis,orelectrolyteimbalance
OR
2. Psychosisintheabsenceofoffendingdrugsorknownmetabolicderangements,e.g.,uremia,
ketoacidosis,orelectrolyteimbalance
[Link]
1. Hemolyticanemiawithreticulocytosis
OR
2. Leukopenia<4,000/mm3on2occasions
OR
3. Lymphopaenia<1,500/mm3on2occasions
OR
4. Thrombocytopenia<100,000/mm3intheabsenceofoffendingdrugs
[Link]
1. AntiDNA:antibodytonativeDNAinabnormaltiter
OR
2. AntiSm:presenceofantibodytoSmnuclearantigen
OR
3. Positivefindingofantiphospholipidantibodieson:
1. anabnormalserumlevelofIgGorIgManticardiolipinantibodies,
2. apositivetestresultforlupusanticoagulantusingastandardmethod,or
3. afalsepositivetestresultforatleast6monthsconfirmedbyTreponemapallidum
immobilizationorfluorescenttreponemalantibodyabsorptiontest
[Link] Anabnormaltiterofantinuclearantibodybyimmunofluorescenceoranequivalentassayatanypointin
antibody timeandintheabsenceofdrugs
