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The 1982 Revised Criteria for Classification of Systemic Lupus Erythematosus

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Criterion

Definition

1. Malar rash

 Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds

2. Discoid rash

 Erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions

3. Photosensitivity

 Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation

4. Oral ulcers

 Oral or nasopharyngeal ulceration, usually painless, observed by physician

5. Arthritis

 Nonerosive arthritis involving 2 or more peripheral joints, characterized by tenderness, swelling, or effusion

6. Serositis
a) Pleuritis--convincing history of pleuritic pain or rubbing heard by a physician or evidence of pleural effusion
OR
b) Pericarditis--documented by ECG or rub or evidence of pericardial effusion

7. Renal disorder
a) Persistent proteinuria greater than 0.5 grams per day or grater than 3+ if quantitation not performed
OR
b) Cellular casts--may be red cell, hemoglobin, granular, tubular, or mixed

8. Neurologic disorder
a) Seizures--in the absence of offending drugs or known metabolic derangements; e.g., uremia, ketoacidosis, or electrolyte imbalance
OR
b) Psychosis--in the absence of offending drugs or known metabolic derangements, e.g., uremia, ketoacidosis, or electrolyte imbalance

9. Hematologic disorder
a) Hemolytic anemia--with reticulocytosis
OR
b) Leukopenia--less than 4,000/mm<>3<> total on 2 or more occasions
OR
c) Lyphopenia--less than 1,500/mm<>3<> on 2 or more occasions
OR
d) Thrombocytopenia--less than 100,000/mm<>3<> in the absence of offending drugs

10. Immunologic disorder
a) Positive LE cell preparation
OR
b) Anti-DNA: antibody to native DNA in abnormal titer
OR
c) Anti-Sm: presence of antibody to Sm nuclear antigen
OR
d) False positive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test

11. Antinuclear antibody

 An abnormal titer of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs known to be associated with "drug-induced lupus" syndrome


* The proposed classification is based on 11 criteria. For the purpose of identifying patients in clinical studies, a person shall be said to have systemic lupus erythematosus if any 4 or more of the 11 criteria are present, serially or simultaneously, during any interval of observation.

Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982;25:1271---7. and Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [letter]. Arthritis Rheum 1997;40:1725.