Smith E L, Shmerling R H
Department of Medicine, Division of Rheumatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Lupus. 1999;8(8):586-95. doi: 10.1191/096120399680411317.
The American College of Rheumatology classification criteria were developed to operationalize the definition of systemic lupus erythematosus (SLE) to allow comparison of clinical research from different centers, but also serve to facilitate education and to guide clinical practice. The classification criteria have been critical to research, but should be viewed as a temporary step until improved understanding of the pathogenesis of SLE emerges. Criteria have inherent limitations, including bias towards more severe and longer duration disease, equal weighting of features that vary in clinical significance, and exclusion of patients with SLE from research because they do not meet criteria. For some SLE research questions, it may be appropriate to include patients diagnosed with SLE who do not meet criteria, if these patients' manifestations and criteria are documented explicitly. SLE disease activity, cumulative organ damage, disease duration, criteria ever met, and criteria met at time of enrollment are important data that should be presented in clinical studies of SLE regardless of the number of criteria met. The criteria should be reevaluated periodically, utilizing patients and controls with a range of diseases and disease severity. A simplified weighting system may more accurately reflect clinical practice.
美国风湿病学会分类标准的制定是为了将系统性红斑狼疮（SLE）的定义具体化，以便不同中心的临床研究能够进行比较，同时也有助于开展教育工作并指导临床实践。该分类标准对研究至关重要，但在对SLE发病机制有更深入了解之前，应将其视为一个临时步骤。分类标准存在固有局限性，包括对病情更严重、病程更长的疾病有偏向性，对临床意义不同的特征给予同等权重，以及因不符合标准而将SLE患者排除在研究之外。对于一些SLE研究问题，如果这些患者的表现和标准有明确记录，纳入未符合标准但被诊断为SLE的患者可能是合适的。SLE疾病活动度、累积器官损伤、病程、曾经符合的标准以及入组时符合的标准都是重要数据，无论符合标准的数量多少，都应在SLE临床研究中呈现。应定期重新评估这些标准，纳入患有一系列疾病且病情严重程度各异的患者和对照。一个简化的加权系统可能更准确地反映临床实践。
