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AMERICAN COLLEGE of RHEUMATOLOGY CLASSIFICATION CRITERIA FOR SLE


There are two sections..one for symptoms of SLE and another for the classification criteria of SLE. These criteria were not meant for diagnosis but form a useful guide.

SYMPTOMS OF SLE

Arthralgia ( Joint aches and pains)
Arthritis ( Joint inflammation, swelling, redness)
Fever (>100*F)
Skin Rashes
Anemia
Kidney Damage
Pleurisy
Facial Rash ( Malar rash, discoid lesions, subacute lesions & not only on face)
Photosensitivity
Alopecia (hair Loss)
Raynauds' Phenomenon
Seizures
Mouth or Nose Ulcers

ACR CRITERIA FOR SLE

Malar Rash
Discoid Rash [Also subacute cutaneous lesions]

Photosensitivity
Oral Ulcers
Arthritis
Serositis (pleuritis or pericarditis)
Renal Disorder (persistent Proteinuria or cellular casts)
Neurological disorder (seizures or psychosis)
Hematologic disorder (hemolytic anemia, Leukopenia or lymphopenia on two or more occasions, thrombocytopenia

Immunologic disorder
a) Anti- ds-DNA: antibody to native DNA in abnormal titer
OR
B) Anti-Sm: presence of antibody to Sm nuclear antigen
OR
c) False positive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test
d) Positive finding of antiphospholipid antibodies based on 1) an abnormal serum level of IgG or IgM anticardiolipin antibodies, 2) a positive test result for lupus anticoagulant using a standard method, or 3) a false-positive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test.

An abnormal titre of ANA at any point in time and in the absence of drugs known to cause an elevated ANA ( 'drug induced lupus')

The American College of Rheumatology (ACR), an organization of doctors and associated health professionals who specialize in arthritis and related diseases of the bones, joints and muscles, has developed and refined a set of classification criteria...if at least 4 of the 11 criteria develop at one time or individually over any period of observation, then the patient is likely to have SLE. However, a diagnosis of SLE can be made in a patient having fewer than four of these symptoms."


Based on

http://www.rheumatology.org/publica...vised_Criteria_Classification_SLE.asp?aud=mem



NB quote from Dr. Michael Lockshin

These criteria classify groups of patients for clinical studies and do not diagnose individual patients. In individual patients, the diagnosis of lupus is fully sustainable with fewer criteria. For instance, a patient who has high titer antinuclear antibody and lupus glomerulonephritis on biopsy, but who has no other symptoms, clearly has lupus even though she has only two criteria. Conversely, a patient with rheumatoid arthritis might have antinuclear antibody, hemolytic anemia or thrombocytopenia, proteinuria, and pleurisy-more than four criteria-and not have lupus. Hence the ACR Criteria should not be used to exclude or confirm the diagnosis of lupus in an individual patient.
Based on http://www.hss.edu/conditions_14138.asp
 

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Hi,

I'd just like to add about the renal abnormalities being more specific than what is sometimes believed:

The ACR criteria state:

a) Proteinuria greater than .5 grams per day or greater than 3+ if quantitation not performed

OR

b) cellular casts - may be red cell, hemoglobin, granular, tubular or mixed

Please bear in mind that kidney infections showing these abnormalities are not necessarily indicative of lupus kidney disease, those abnormalities can show up in someone who does not have lupus , they are suffering from a raging renal infection. There would be far more weight added if NO evidence of infection exists at the same time. Repeat testing should be done after the infection has subsided to make the situation more clear.

love
Lily
 
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