Radin Massimo, Schreiber Karen, Cecchi Irene, Bortoluzzi Alessandra, Crisafulli Francesca, de Freitas Cristiano M, Bacco Beatrice, Rubini Elena, Foddai Silvia G, Padovan Melissa, Gallo Cassarino Silvia, Franceschini Franco, Andrade Danieli, Benedetto Chiara, Govoni Marcello, Bertero Tiziana, Marozio Luca, Roccatello Dario, Andreoli Laura, Sciascia Savino
S. Giovanni Bosco Hospital and University of Turin, Turin, Italy.
Guy's and St Thomas' Hospital, London, UK, and Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Arthritis Care Res (Hoboken). 2021 Dec;73(12):1804-1808. doi: 10.1002/acr.24391. Epub 2021 Oct 4.
We aimed to investigate the impact of applying the 2019 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus (SLE) in a previously described cohort of women with undifferentiated connective tissue disease (UCTD).
This study included 133 women with UCTD. At the time of inclusion into the study, none of the patients met any classification criteria for other defined systemic connective tissue disease.
When applying the 2019 EULAR/ACR classification criteria to the cohort, 22 patients (17%) fulfilled the classification criteria for SLE. Patients classified as having SLE had significantly higher frequencies of mucocutaneous manifestations (23% versus 5%; P = 0.007), arthritis (59% versus 17%; P < 0.001), isolated urine abnormalities (18% versus 1%; P < 0.001), and highly specific antibodies (50% versus 15%; P < 0.001) compared to the other patients with UCTD. At follow-up, these patients were statistically significantly more likely to also meet the 1997 ACR revised SLE criteria and the Systemic Lupus International Collaborating Clinics (SLICC) criteria (18.2% versus 1.8%; P < 0.001) compared to the other UCTD patients. Patients who were diagnosed as having SLE according to the ACR 1997 update of the SLE revised criteria and the SLICC criteria during the follow-up scored higher on outcome measures when classified as having SLE according to the new 2019 EULAR/ACR classification criteria when compared to the other patients with UCTD (mean ± SD score 8.3 ± 3.7 versus 4.5 ± 4; P < 0.05).
When applying the 2019 EULAR/ACR criteria for SLE in a cohort of patients with UCTD, we observed that in up to 17% of cases the original classification could be challenged. New implementation will help to identify earlier patients at higher risk of developing more severe CTD manifestations.
我们旨在研究应用2019年欧洲风湿病学会联盟（EULAR）/美国风湿病学会（ACR）系统性红斑狼疮（SLE）分类标准，对先前描述的未分化结缔组织病（UCTD）女性队列的影响。
本研究纳入了133例UCTD女性患者。在纳入研究时，没有患者符合其他明确的系统性结缔组织病的任何分类标准。
将2019年EULAR/ACR分类标准应用于该队列时，22例患者（17%）符合SLE分类标准。与其他UCTD患者相比，被分类为患有SLE的患者出现黏膜皮肤表现（23%对5%；P = 0.007）、关节炎（59%对17%；P < 0.001）、单纯性尿液异常（18%对1%；P < 0.001）和高特异性抗体（50%对15%；P < 0.001）的频率显著更高。在随访中，与其他UCTD患者相比，这些患者在统计学上也更有可能符合1997年ACR修订的SLE标准和系统性红斑狼疮国际协作临床中心（SLICC）标准（18.2%对1.8%；P < 0.001）。在随访期间根据ACR 1997年SLE修订标准和SLICC标准被诊断为患有SLE的患者，当根据新的2019年EULAR/ACR分类标准被分类为患有SLE时，与其他UCTD患者相比，在结局指标上得分更高（平均±标准差评分8.3±3.7对4.5±4；P < 0.05）。
在UCTD患者队列中应用2019年EULAR/ACR SLE标准时，我们观察到高达17%的病例中原来的分类可能受到挑战。新的应用将有助于更早地识别出有发展为更严重CTD表现更高风险的患者。
