Updating the American
College of Rheumatology Revised Criteria for the Classification of Systemic
Lupus Erythematosus
To the Editor:
In 1982, the Diagnostic and Therapeutic Criteria Committee of the American
College of Rheumatology (ACR)published revised criteria for the classification
of systemiclupus erythematosus (SLE) (1). During the ensuing decade several
investigators, including Drs. Graham Hughes and Donato Alarcon-Segovia, among
others, have described the presence and clinical associations or antiphospholipid
antibodies in patients with SLE, as well as the occurrence of theprimary antiphospholipid
syndrome (2-5). In 1992, Piette and colleagues suggested that the ACR revised
criteria be reevaluated in light of the above discoveries (6).
At the request of Dr. Eng Tan, the Diagnostic and Therapeutic Criteria Committee
of the ACR reviewed the 1982 revised criteria for SLE and recommended tne following
revisions to criterion number 10 ("Immunologic disorder"),which were
approved by the Council on Research and the Board of Directors:
1. Delete item 10(a) ("Positive
LE cell preparation"), and
2. Change item lO(d) to
"Positive finding of antiphospholipid antibodies based on 1) an abnormal
serum level of IgG or IgM anticardiolipin antibodies, 2) a positive test result
for lupus anticoagulant using a standard method, or 3) a 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."Standard methods should be used in testing for the presence
of antiphospholipid (7-10). Publication of this letter will allow basic and
clinical investigators in SLE to not only use, but also cite, the modification
of the 1982 criteria.Marc C. Hochberg, MD, MPH for the Diagnostic and Therapeutic
Criteria Committeee of the American College of Rheumatology1. Tan EM, Cohen
AS, Fries JF, Masi AT, McShane DJ, RothfieldNF, Schaller JG, Talal N, Winchester
RJ: The 1982 revised criteria for the classification of systemic lupus erythematosus.
Arthritis Rheum 25:1271-1277, 1982
2. Harris EN, Gharavi AK,
Boey M, Patel BM, Mackworth-Young CG, Loizou S, Hughes GRV: Anticardiolipin
antibodies: detection by radioimmunoassay and association with thrombosis in
systemiclupus erythematosus. Lancet 2:1211-1214, 19833. Alarcon-Segovia D, Deleze
M, Oria CV, Sanchez-Guerrero J, Gomez-Pacheco L, Cabiedes J, Fernandez A, Ponce
de Leon S: Antiphospholipid antibodies and the antiphospholipid syndrome in
systemic lupus erythematosus: a prospective analysis of 500 consecutive patients.
Medicine (Baltimore) 68:353-365, 19894. Asherson RA, Khamashta MA, Ordi-Ros
J, Derksen RHWM, Machin SJ, Barquinero J, Out HH, Harris EN, Vilarde-Torres
M, Hughes GRV: The primary antiphospholipid syndrome: major clinical and serological
features. Medicine (Baltimore) 68:366374, 19895. Alarcon-Segovia D: Antiphospholipid
syndrome within systemic lupus erythematosus. 3:289-291, 19946. Piette JC, Wechsler
B. Frances C, Godeau P: Systemic lupus erythematosus and the antiphospholipid
syndrome: reflections about the relevance of ARA criteria. J Rheumatol 19:1835-1837,
19927. Harris EN, Gharavi AK, Patel BM, Hughes GRV: Evaluation of the anticardiolipin
antibody test: report of an international workshop held 4 April 1986. Clin Exp
Immunol 68:215-222, 1987 8.. Harris EN, Phil M: The second international anticardiolipin
standardization workshop: The Kingston Antiphospholipid Antibody Study (KAPS)
Group. Am J Clin Pathol 94:474-484, 19909. Exner T, Triplett DA, Taberner D,
Machin SJ: Guidelines fortesting and revised criteria for lupus anticoagulants:
Subcommitteefor the Standardization of Lupus Anticoagulants. Thromb Haemost
65:320-322, 199110. Brandt JT, Triplett DA, Alving B. Scharrer I: Scientific
and Standardization Committee Commumcations: criteria for the diagnosis of lupus
anticoagulants—an update. Thromb Haemost 74:1185-1190, 1995
Hochberg MC. Updating
the American College of Rheumatology revised criteria for the classification
of systemic lupus erythematosus [letter]. Arthritis Rheum 1997;40:1725.
