Bayesian Revision of the Decision Rule for the Classification of Systemic Lupus Erythematosus
In November 1982, a Subcommittee of the American Rheumatism Association published (1) the revised criteria for the classification of systemic lupus erythematosus (SLE), updating the preliminary list of criteria in use since 1971 (2). As reported by Tan et al., the Subcommittee evaluated 177 patients with SLE, contributed by 18 major institutions from the United States and Canada. The control group comprised 162 age-, sex.-, and race-matched patients with a variety of non-traumatic, non-degenerate connective-tissue diseases. Ninety-five patients in the control group had confirmed rheumatoid arthritis, 16 had scleroderma, 7 had juvenile onset arthritis, 6 had dermatomyositis, and 5 each had ankylosing spondolylitis and psoriatic arthritis. The remaining 28 patients in the control group had been diagnosed to have one of l6 other diseases. Thirty potential criteria variables, including each of the original 1971 preliminary criteria, were analyzed, and 11 were selected for a final set. The 11 final criteria were: malar rash (MAL); discoid rash (DIS); photosensitivity (PHO); oral ulcers (ORA); non-erosive arthritis (ART); serositis (SER); renal disorder (REN) consisting of persistent proteinuria or cellular casts; neurologic disorder (NEU) consisting of seizures or psychosis; hematologic disorder (HEM) consisting of hemolytic anemia or leukopenia or lymphopenia or thrombocytopenia; immunologic disorder (IMM) consisting of positive LE cell preparation or abnormal titers of antibody to native DNA or Sm nuclear antigen or a false positive serologic test for syphilis; abnormal titers of antinuclear antibody (ANA).
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