Criteria for classification of SLE (systemic lupus erythematosus)

1997 updated American College of Rheumatology (ACR) criteria for classification of SLE

A person is considered to have SLE if at least 4 of the 11 criteria are present, serially or simultaneously, during any interval of observation.

• malar rash - fixed erythema over the malar eminences, tending to spare the nasolabial folds
• discoid rash - erythematous, raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions
• photosensitivity - skin rash as a result of unusual reaction to sunlight, by patient history or physician observation
• oral ulcers - oral or nasopharyngeal ulceration, usually painless, observed by physician
• arthritis - non-erosive, involving two or more peripheral joints, characterized by tenderness, swelling, or effusion
• serositis
  • pleuritis - convincing history of pleuritic pain or rubbing heard by a physician or evidence of pleural effusion
  • pericarditis - documentation on electrocardiography, rubbing, or evidence of pericardial effusion
• renal disorder
  • persistent proteinuria: greater than 0.5 g per day or greater than 3+ if quantitation not performed
  • cellular casts: may be red blood cell, hemoglobin, granular, tubular, or mixed
• neurological disorder
  • seizures: in the absence of offending drugs or known metabolic derangements (e.g., uremia, ketoacidosis, electrolyte imbalance)
  • psychosis: in the absence of offending drugs or known metabolic derangements (e.g., uremia, ketoacidosis, electrolyte imbalance)
• haematological disorder
  • hemolytic anemia: with reticulocytosis
  • leukopenia: lymphocyte count less than 4,000 per µL (4 × 109 per L) on two or more occasions
  • lymphopenia: lymphocyte count less than 1,500 per µL (1.5 × 109 per L) on two or more occasions
  • thrombocytopenia: platelet count less than 100 × 103 per µL (100 × 109 per L) in the absence of offending drugs
• immunological disorder
  • a) anti-DNA antibodies
  • b) anti-Sm antibodies
  • c) anti-phospholipid antibodies
• anti-nuclear antibody - exclude drug causes (1,2)

Reference:

• (1) Gibson K, Goodemote P, Johnson S.  FPIN's clinical inquiries: antibody testing for systemic lupus erythematosus. Am Fam Physician. 2011;84(12):1407-9.
• (2) Arthritis Research UK. Reports on Rheumatic Diseases. Topical Reviews No 2, spring 2013. Overview of management of systemic lupus erythematosus.