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dc.contributor.authorAringer, Martin
dc.contributor.authorBrinks, Ralph
dc.contributor.authorDoerner, Thomas
dc.contributor.authorDaikh, David
dc.contributor.authorMosca, Marta
dc.contributor.authorRamsey-Goldman, Rosalind
dc.contributor.authorSmolen, Josef S.
dc.date.accessioned2021-06-10T19:38:28Z
dc.date.available2021-06-10T19:38:28Z
dc.date.issued2021
dc.identifier.issn0003-4967
dc.identifier.issn1468-2060
dc.identifier.urihttps://doi.oeg/10.1136/annrheumdis-2020-219373
dc.identifier.urihttp://hdl.handle.net/11446/4345
dc.descriptionIzmirly, Peter/0000-0001-5445-2182; Doria, Andrea/0000-0003-0548-4983en_US
dc.descriptionPubMed: 33568386en_US
dc.descriptionWOS:000654337600032en_US
dc.description.abstractBackground/objectives The European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 classification criteria for systemic lupus erythematosus system showed high specificity, while attaining also high sensitivity. We hereby analysed the performance of the individual criteria items and their contribution to the overall performance of the criteria. Methods We combined the EULAR/ACR derivation and validation cohorts for a total of 1197 systemic lupus erythematosus (SLE) and n=1074 non-SLE patients with a variety of conditions mimicking SLE, such as other autoimmune diseases, and calculated the sensitivity and specificity for antinuclear antibodies (ANA) and the 23 specific criteria items. We also tested performance omitting the EULAR/ACR criteria attribution rule, which defines that items are only counted if not more likely explained by a cause other than SLE. Results Positive ANA, the new entry criterion, was 99.5% sensitive, but only 19.4% specific, against a non-SLE population that included other inflammatory rheumatic, infectious, malignant and metabolic diseases. The specific criteria items were highly variable in sensitivity (from 0.42% for delirium and 1.84% for psychosis to 75.6% for antibodies to double-stranded DNA), but their specificity was uniformly high, with low C3 or C4 (83.0%) and leucopenia <4.000/mm(3) (83.8%) at the lowest end. Unexplained fever was 95.3% specific in this cohort. Applying the attribution rule improved specificity, particularly for joint involvement. Conclusions Changing the position of the highly sensitive, non-specific ANA to an entry criterion and the attribution rule resulted in a specificity of >80% for all items, explaining the higher overall specificity of the criteria set.en_US
dc.description.sponsorshipEULAR; ACR; Intramural Research Programme of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Healthen_US
dc.description.sponsorshipThe classification criteria project has been jointly funded by EULAR and the ACR. This research was supported in part by the Intramural Research Programme of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.en_US
dc.language.isoengen_US
dc.publisherBmj Publishing Groupen_US
dc.relation.isversionof10.1136/annrheumdis-2020-219373en_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectlupus erythematosusen_US
dc.subjectsystemicen_US
dc.subjectantibodiesen_US
dc.subjectantiphospholipiden_US
dc.subjectautoantibodiesen_US
dc.subjectsynovitisen_US
dc.titleEuropean League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) SLE classification criteria item performanceen_US
dc.typearticleen_US
dc.relation.journalAnnals Of The Rheumatic Diseasesen_US
dc.contributor.department[0-Belirlenecek]en_US
dc.identifier.issue6en_US
dc.identifier.volume80en_US
dc.identifier.startpage775en_US
dc.identifier.endpage781en_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.contributor.institutionauthor[0-Belirlenecek]


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