Abstract
The American College of Rheumatology (ACR) classification criteria for lupus and Systemic Lupus International Collaborating Clinics (SLICC) criteria are designed to classify disease. However, they have become widely used as diagnostic criteria in clinical situations. Patients may be labelled as systemic lupus erythematosus (SLE) in their medical records, when in fact they have cutaneous lupus erythematosus (CLE) without systemic symptoms. We sought to investigate how many of our cutaneous lupus patients attending a dermatology lupus clinic were mislabelled as either CLE or SLE using the ACR and SLICC criteria. Thirty-six patients with biopsy-proven cutaneous lupus were identified. Fourteen (39%) of the patients were labelled as ‘SLE’ in their medical notes, either by dermatology or another medical team. Of these 14 patients, 12 (86%) fulfilled the ACR and SLICC criteria; however, two (14%) did not meet the criteria for SLE. Of the remaining 22 patients who were not labelled as having SLE, four (18%) met both the SLICC and ACR criteria, one (5%) met the ACR criteria and one (5%) met the SLICC criteria. These patients had a history of discoid or subacute lupus, with very few systemic symptoms. They met the criteria for SLE primarily on their cutaneous signs and positive serology. It is important to screen patients with CLE routinely for SLE. Although the ACR and SLICC criteria can be helpful as they have a high sensitivity for systemic lupus, their use needs to be paired with the clinical context and patient evolution. We found patients were labelled as SLE when in fact they had no evidence of systemic involvement, as well as patients labelled as cutaneous lupus who fulfilled the criteria for SLE, although unlikely having any systemic involvement. It is important to correctly identify patients as ‘cutaneous lupus’ or ‘systemic lupus erythematosus’ and documentation in clinical notes should be accurate to avoid confusion and allow appropriate treatment.
References
Petri M, Orbai AM, Alarcon GS, Gordon C, Merrill JT, Fortin PR et al (2012) Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 64(8):2677–2686. https://doi.org/10.1002/art.34473
Yu C, Gershwin ME, Chang C (2014) Diagnostic criteria for systemic lupus erythematosus: a critical review. J Autoimmun 48-49:10–13. https://doi.org/10.1016/j.jaut.2014.01.004
Tiao J, Feng R, Carr K, Okawa J, Werth VP (2016) Using the American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria to determine the diagnosis of systemic lupus erythematosus (SLE) in patients with subacute cutaneous lupus erythematosus (SCLE). J Am Acad Dermatol 74:862–869
Chong BF, Song J, Olsen NJ (2012) Determining risk factors for developing systemic lupus erythematosus in patients with discoid lupus erythematosus. Br J Dermatol 166:29–35
Okon LG, Werth V (2013) Cutaneous lupus erythematosus: diagnosis and treatment. Best Prac Res Clin Rheumatol 27(3):391–404. https://doi.org/10.1016/j.berh.2013.07.008
Merola JF, Nyberg F, Furukawa F, Goodfield MJ, Hasegawa M, Marinovic B, Szepietowski J, Dutz J, Werth JP (2015) Redefining cutaneous lupus erythematosus: a proposed international consensus approach and results of a preliminary questionnaire. Lupus Sci Med 2(1):e000085. https://doi.org/10.1136/lupus-2015-000085
Franks A, Guilabert A (2015) Cutaneous lupus erythematosus: a lone wolf? Lupus Sci Med 2(1):e000090. https://doi.org/10.1136/lupus-2015-000090
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Flynn, A., Gilhooley, E., O’Shea, F. et al. The use of SLICC and ACR criteria to correctly label patients with cutaneous lupus and systemic lupus erythematosus. Clin Rheumatol 37, 817–818 (2018). https://doi.org/10.1007/s10067-018-3999-0
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DOI: https://doi.org/10.1007/s10067-018-3999-0