Albrecht J, Berlin J A, Braverman I M, Callen J P, Connolly M K, Costner M I, Dutz J, Fivenson D, Franks A G, Jorizzo J L, Lee L A, McCauliffe D P, Sontheimer R D, Werth V P
Department of Dermatology, University of Pennsylvania, PA, USA.
Lupus. 2004;13(11):839-49. doi: 10.1191/0961203304lu2020oa.
The 1982 ACR classification criteria have become de facto diagnostic criteria for systemic lupus erythematosus (SLE), but a review of the criteria is necessary to include recent diagnostic tests. The criteria were not developed with the help of dermatologists, and assign too much weight to the skin as one expression of a multiorgan disease. Consequently, patients with skin diseases are classified as SLE based mostly on skin symptoms. We discuss specific problems with each dermatologic criterion, but changes must await a new study. We suggest the following guidelines for such a study, aimed at revision of the criteria. 1) The SLE patient group should be recruited in part by dermatologists. 2) The study should evaluate an appropriate international ethnic/racial mix, including late onset SLE as well as pediatric patients. 3) All patients should have current laboratory and clinical evaluations, as suggested in the paper, to assure the criteria can be up-to-date. This includes anti-SS-A and anti-SS-B antibodies and skin biopsies for suspected cutaneous lupus erythematosus except for nonscarring alopecia and oral ulcers. 4) The study should be based on a series of transparent power calculations. 5) The control groups should represent relevant differential diagnoses in numbers large enough to assess diagnostic problems that might be specific to these differential diagnoses. In order to demonstrate specificity of the criteria with a 95% confidence interval between 90 and 100%, each control group of the above should have at least 73 patients.
1982年美国风湿病学会（ACR）分类标准已成为系统性红斑狼疮（SLE）事实上的诊断标准，但有必要对这些标准进行审视，以纳入近期的诊断检测方法。这些标准并非在皮肤科医生的协助下制定，且将皮肤作为多器官疾病的一种表现形式赋予了过多权重。因此，患有皮肤病的患者大多仅基于皮肤症状就被归类为SLE。我们讨论了每个皮肤科标准存在的具体问题，但修改必须等待新的研究。我们针对这样一项旨在修订标准的研究提出以下指导原则。1）SLE患者组部分应由皮肤科医生招募。2）该研究应评估适当的国际种族/民族组合，包括晚发型SLE以及儿科患者。3）所有患者都应按照本文建议进行当前的实验室和临床评估，以确保标准能够与时俱进。这包括抗SS - A和抗SS - B抗体检测，以及对疑似皮肤型红斑狼疮进行皮肤活检，但不包括非瘢痕性脱发和口腔溃疡。4）该研究应基于一系列透明的功效计算。5）对照组应在数量上代表相关的鉴别诊断，其数量应足够大，以评估可能特定于这些鉴别诊断的诊断问题。为了在90%至100%的95%置信区间内证明标准的特异性，上述每个对照组应至少有73名患者。
