title: Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus.
abstract: OBJECTIVE
  The Systemic Lupus International Collaborating Clinics (SLICC) group revised and validated the American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria in order to improve clinical relevance, meet stringent methodology requirements, and incorporate new knowledge regarding the immunology of SLE.
  
  
  METHODS
  The classification criteria were derived from a set of 702 expert-rated patient scenarios. Recursive partitioning was used to derive an initial rule that was simplified and refined based on SLICC physician consensus. The SLICC group validated the classification criteria in a new validation sample of 690 new expert-rated patient scenarios.
  
  
  RESULTS
  Seventeen criteria were identified. In the derivation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (49 versus 70; P = 0.0082) and had greater sensitivity (94% versus 86%; P < 0.0001) and equal specificity (92% versus 93%; P = 0.39). In the validation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (62 versus 74; P = 0.24) and had greater sensitivity (97% versus 83%; P < 0.0001) but lower specificity (84% versus 96%; P < 0.0001).
  
  
  CONCLUSIONS
  The new SLICC classification criteria performed well in a large set of patient scenarios rated by experts. According to the SLICC rule for the classification of SLE, the patient must satisfy at least 4 criteria, including at least one clinical criterion and one immunologic criterion OR the patient must have biopsy-proven lupus nephritis in the presence of antinuclear antibodies or anti-double-stranded DNA antibodies.
authors.affiliation: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD 21205, USA. mpetri@jhmi.edu
authors.forename: Michelle
authors.initials: M
authors.lastname: Petri
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Orbai
authors.forename: Graciela S
authors.initials: GS
authors.lastname: Alarcón
authors.forename: Caroline
authors.initials: C
authors.lastname: Gordon
authors.forename: Joan T
authors.initials: JT
authors.lastname: Merrill
authors.forename: Paul R
authors.initials: PR
authors.lastname: Fortin
authors.forename: Ian N
authors.initials: IN
authors.lastname: Bruce
authors.forename: David
authors.initials: D
authors.lastname: Isenberg
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wallace
authors.forename: Ola
authors.initials: O
authors.lastname: Nived
authors.forename: Gunnar
authors.initials: G
authors.lastname: Sturfelt
authors.forename: Rosalind
authors.initials: R
authors.lastname: Ramsey-Goldman
authors.forename: Sang-Cheol
authors.initials: SC
authors.lastname: Bae
authors.forename: John G
authors.initials: JG
authors.lastname: Hanly
authors.forename: Jorge
authors.initials: J
authors.lastname: Sánchez-Guerrero
authors.forename: Ann
authors.initials: A
authors.lastname: Clarke
authors.forename: Cynthia
authors.initials: C
authors.lastname: Aranow
authors.forename: Susan
authors.initials: S
authors.lastname: Manzi
authors.forename: Murray
authors.initials: M
authors.lastname: Urowitz
authors.forename: Dafna
authors.initials: D
authors.lastname: Gladman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kalunian
authors.forename: Melissa
authors.initials: M
authors.lastname: Costner
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Werth
authors.forename: Asad
authors.initials: A
authors.lastname: Zoma
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.forename: Munther A
authors.initials: MA
authors.lastname: Khamashta
authors.forename: Soren
authors.initials: S
authors.lastname: Jacobsen
authors.forename: Jill P
authors.initials: JP
authors.lastname: Buyon
authors.forename: Peter
authors.initials: P
authors.lastname: Maddison
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Dooley
authors.forename: Ronald F
authors.initials: RF
authors.lastname: van Vollenhoven
authors.forename: Ellen
authors.initials: E
authors.lastname: Ginzler
authors.forename: Thomas
authors.initials: T
authors.lastname: Stoll
authors.forename: Christine
authors.initials: C
authors.lastname: Peschken
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Jorizzo
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Callen
authors.forename: S Sam
authors.initials: SS
authors.lastname: Lim
authors.forename: Barri J
authors.initials: BJ
authors.lastname: Fessler
authors.forename: Murat
authors.initials: M
authors.lastname: Inanc
authors.forename: Diane L
authors.initials: DL
authors.lastname: Kamen
authors.forename: Anisur
authors.initials: A
authors.lastname: Rahman
authors.forename: Kristjan
authors.initials: K
authors.lastname: Steinsson
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Franks
authors.forename: Lisa
authors.initials: L
authors.lastname: Sigler
authors.forename: Suhail
authors.initials: S
authors.lastname: Hameed
authors.forename: Hong
authors.initials: H
authors.lastname: Fang
authors.forename: Ngoc
authors.initials: N
authors.lastname: Pham
authors.forename: Robin
authors.initials: R
authors.lastname: Brey
authors.forename: Michael H
authors.initials: MH
authors.lastname: Weisman
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Magder
mesh_terms: D000888:Antibodies, Anti-Idiotypic / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D001706:Biopsy; D004247:DNA / Q000276:immunology; D006801:Humans; D007390:International Agencies; D008180:Lupus Erythematosus, Systemic / Q000145:classification* / Q000175:diagnosis* / Q000276:immunology; D008181:Lupus Nephritis / Q000473:pathology; D012680:Sensitivity and Specificity
chemical_list: D000888:Antibodies, Anti-Idiotypic; D000974:Antibodies, Antinuclear; D004247:DNA