ARA and EADV criteria for classification of systemic lupus erythematosus in patients with cutaneous lupus erythematosus.
OBJECTIVE
To verify (1) how many patients with cutaneous lupus erythematosus (CLE) fulfill 4 or more American Rheumatism Association (ARA) and European Academy of Dermatology and Venereology (EADV) criteria for classification of systemic lupus erythematosus (SLE); (2) which criteria are mostly fulfilled; (3) the severity of the disease in patients fulfilling criteria; (4) how many patients with systemic involvement fail to fulfill 4 ARA and EADV criteria.


METHODS
We studied 207 patients with chronic and subacute CLE, classified according to ARA and EADV criteria.


RESULTS
Twenty-four patients with localized discoid (L-DLE; 21.8%), 22 with disseminated discoid (D-DLE; 30.5%) and 7 with subacute CLE (SCLE; 28%) had 4 or more ARA criteria. With EADV criteria, these figures fell to 7 (6.4%), 7 (9.7%) and 6 (24%), respectively. Only 3 L-DLE (2.7%), 5 D-DLE (6.9%) and 3 SCLE cases (12%) defined as SLE by ARA criteria and 1, 3 and 3, respectively, by EADV criteria had a renal or neurological disorder, hemolytic anemia and/or thrombocytopenia, vasculitis or serositis. ARA criteria did not classify 7 patients with a similar visceral involvement, while EADV criteria failed in 11 patients.


CONCLUSIONS
In our patients, ARA criteria showed a sensitivity of 88%, a specificity of 79%, a positive predictive value of 56% and a negative predictive value of 96%. EADV criteria showed a sensitivity of only 64%, but a specificity of 93%, a positive predictive value of 61% and a negative predictive value of 94%. ARA criteria should not be used in CLE patients as they are too sensitive, poorly specific and altogether misleading. EADV criteria are more specific, but less sensitive.
Parodi
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Department of Dermatology, University of Genoa, Italy.
Rebora
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D000743:Anemia, Hemolytic / Q000473:pathology; D003880:Dermatology; D005060:Europe; D005189:False Positive Reactions; D006801:Humans; D007674:Kidney Diseases / Q000473:pathology; D008178:Lupus Erythematosus, Cutaneous / Q000145:classification* / Q000473:pathology; D008179:Lupus Erythematosus, Discoid / Q000145:classification* / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000145:classification* / Q000473:pathology; D009422:Nervous System Diseases / Q000473:pathology; D011237:Predictive Value of Tests; D012219:Rheumatology; D012680:Sensitivity and Specificity; D012700:Serositis / Q000473:pathology; D012720:Severity of Illness Index; D012955:Societies, Medical; D013921:Thrombocytopenia / Q000473:pathology; D014481:United States; D014657:Vasculitis / Q000473:pathology; D014686:Venereology