2009 SLICC Modified ACR Classification Criteria for Systemic Lupus Erythematosus
Clinical criteria
1. acute or subacute cutaneous lupus.
2. chronic cutaneous lupus.
3. oral/nasal ulcers.
4, alopecia without scarring.
5, inflammatory synovitis with swelling of two or more joints or joint tenderness with morning stiffness as observed by the internist.
6. plagiocephaly.
7. kidneys: at least 500 mg of protein/24 hours, as counted by the urine protein/creatinine ratio (or 24-hour urine protein), or with erythrocyte tubularity.
8, neurological: purpura seizures, psychosis, polyneuritis moniliformis, myelitis, peripheral or cranial neuropathy, encephalitis (acute state of mental confusion.
9, hemolytic anemia.
10, leukopenia (< 4000/mm3 at least once) or lymphopenia (< 1000/mm3 at least once).
11, at least one thrombocytopenia (< 100,000/mm3).
Immunological criteria
1, ANA above the laboratory reference range.
2, anti-ds-DNA above the laboratory reference range (ELISA method additionally, two tests above the laboratory reference range are required with this method).
3, anti-sm positive.
4. antiphospholipid antibodies.
①positive lupus anticoagulant.
② false positive syphilis serological test.
③ anticardiolipin antibodies-at least twice normal or moderate to high titers.
④positive anti-b2 glycoprotein 1.
5. low complement.
(i) low C3.
② low C4.
③ low CH50.
6. positive direct coombs test in the absence of hemolytic anemia.
Patients are classified as having SLE if they meet at least one of the following conditions.
1. there is biopsy-proven lupus nephritis with positive ANA or positive anti-ds-DNA
2. The patient meets four of the classification criteria, including at least one clinical criterion and one immunological criterion .
Application of this criterion in the enrolled patients had better sensitivity (94% vs. 86%) and approximately the same specificity (92% vs. 93%) as the ACR criteria, with significantly less misclassification (p=0.0082).