Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
Ann Rheum Dis. 2021 Jun;80(6):767-774. doi: 10.1136/annrheumdis-2020-218670. Epub 2021 Jan 15.
To determine the ominosity of the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) Systemic Lupus Erythematosus Classification Criteria by determining its predictive role for disease severity in the first 5 years following diagnosis.
867 patients with systemic lupus erythematosus (SLE) from the Toronto Lupus Clinic were included (all first 12 months after SLE diagnosis). The EULAR/ACR criteria score was calculated based on baseline information. To determine disease severity in the first 5 years after diagnosis, adjusted mean SLE Disease Activity Index 2000 (AMS), flares, remission and immunosuppressive treatment were used as outcomes. The Systemic Lupus International Collaborating Clinics (SLICC) registry comprised the validation cohort.
Based on receiver operating characteristic analysis, a EULAR/ACR score of 20 was used as a threshold to compare outcomes between groups. In the first 5 years of disease course, patients with a score of ≥20 had higher AMS scores (p<0.001) and were more likely to ever experience a flare (p<0.001). These patients had lower probabilities of achieving remission and higher requirements for immunosuppressives. Results were confirmed in the SLICC validation cohort. Patients with a score of ≥20 had higher AMS during the first 5 years of disease (5.4 vs 3.1% and ≥20 vs <20 respectively, p≤0.001). The score correlated with AMS (r=0.43, p≤0.001) in the same time frame.
A EULAR/ACR score of ≥20 is an indicator of ominosity in SLE. Patients with a score of ≥20 were characterised by a more active disease course throughout the first 5 years. These criteria provide prognostic information regarding disease severity in the first 5 years following diagnosis.
通过确定欧洲抗风湿病联盟（EULAR）/美国风湿病学会（ACR）系统性红斑狼疮分类标准对诊断后 5 年内疾病严重程度的预测作用，来确定该标准的凶险程度。
纳入了来自多伦多狼疮诊所的 867 例系统性红斑狼疮（SLE）患者（均在 SLE 诊断后 12 个月内）。根据基线信息计算 EULAR/ACR 标准评分。为了确定诊断后 5 年内的疾病严重程度，使用调整后的平均 SLE 疾病活动指数 2000（AMS）、发作、缓解和免疫抑制治疗作为结局。系统性红斑狼疮国际合作临床（SLICC）登记处构成验证队列。
基于受试者工作特征分析，将 EULAR/ACR 评分≥20 作为比较组间结局的阈值。在疾病病程的前 5 年，评分≥20 的患者 AMS 评分更高（p<0.001），且更有可能经历发作（p<0.001）。这些患者达到缓解的可能性更低，对免疫抑制剂的需求更高。结果在 SLICC 验证队列中得到了证实。评分≥20 的患者在疾病的前 5 年内 AMS 更高（分别为 5.4%和 3.1%，≥20 和 <20，p≤0.001）。该评分与同一时间段内的 AMS 相关（r=0.43，p≤0.001）。
EULAR/ACR 评分≥20 是 SLE 凶险程度的指标。评分≥20 的患者在疾病的前 5 年内表现为更活跃的病程。这些标准提供了诊断后 5 年内疾病严重程度的预后信息。
