Clinical criteria.
1. acute or subacute cutaneous lupus.
2. chronic cutaneous lupus.
3. oral/nasal ulcers.
4, hair loss 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, 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.
③Low CH50.
6. In the absence of hemolytic anemia, a positive direct coombs test
Patients were classified as SLE if they met at least one of the following conditions: 1. There was biopsy-proven lupus nephritis with positive ANA or positive anti-ds-DNA; 2. Patients met 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, while significantly reducing misclassification (p=0, 0082)
In fact, it is because I saw that many of the translated criteria on the Internet were ambiguous that I am posting the original English and my own translation. I think it is best to read the original text to gain a correct understanding.
1, the fourth clinical standard Nonscarring alopecia.
alopecia translates as “hair loss”, but what does “baldness” mean? It’s a bit baffling, the Chinese says “baldness”, which says “baldness”.
2. The problem of arthritis.
There are two definitions of arthritis in this new standard, one is the swelling of two or more joints as observed by the doctor, and the other is tenderness with morning stiffness. Any one of these can be considered arthritis. It is not a matter of joint pain. If joint tenderness is accompanied by morning stiffness, it is also considered inflammatory synovitis.
3. The problem of several types of cutaneous lupus: there is a passage that can be referred to and drawn from.
The Bundick and Ellis classification adopted in the 1950s is: ① limited discoid lupus erythematosus; ② disseminated lupus erythematosus, which is subdivided into acute, subacute and chronic disseminated lupus erythematosus, (disseminated discoid lupus erythematosus). As research on the disease became more extensive and in-depth, a number of classifications emerged. The disease has been classified by Kitamura according to the nature of the lesions as follows: (1) incomplete type (stroke-type); (2) chronic discoid dry type; (3) chronic discoid exudate; (4) pigmented hyperplasia; (5) chronic disseminated type; and (6) acute disseminated type. Gilliam classified patients with lesions regardless of whether they had extracutaneous lesions into: (1) chronic cutaneous lupus erythematosus (CCLE), which can be divided into limited discoid lupus erythematosus, generalized discoid lupus erythematosus, hypertrophic discoid lupus erythematosus, and deep lupus erythematosus; (2) subacute cutaneous lupus erythematosus (SCLE); and (3) acute lupus erythematosus, which can be divided into facial (zygomatic) erythematosus, facial, scalp, neck, upper chest, shoulder and arm extensor surfaces, and acute lupus erythematosus. erythema of upper chest, shoulder and arm extensions and dorsal hands, and maculopapular or toxic epidermolysis bullosa-like lesions. Some people prefer to classify only the discoid and systemic types; the former is subdivided into: (1) limited discoid type and (2) pan-occurring discoid type. Some people also advocate changing the discoid type to cutaneous lupus erythematosus. It is now believed that lupus erythematosus is a spectrum disease, with limited discoid and systemic lupus erythematosus (SLE) as its two extreme types, with subacute cutaneous lupus erythematosus and deep lupus erythematosus in between.
After reading this paragraph, I believe that the idea is much clearer. Acute cutaneous lupus is that of maculopapular or toxic epidermolysis bullosa-like damage. The subacute and chronic ones are more often talked about in dermatology.
4. On the immunological criteria in Article 6.
The original text is Direct Coombs test in absence of hemolytic anemia, this sentence in absence of, meaning “lack, no, absence” and so on, “lack, no, absence The “lack of, absence of, absence of” is the thing behind of, not in absence of the “Direct Coombs test”, so, in fact, the meaning is very clear, that is, “in the absence of hemolytic anemia, the Direct Coombs test is positive “The meaning is clear. If it is translated as “with hemolytic anemia but negative Coombs test”, it is not only incorrect, but also contradictory to the previous article and to the disease of lupus, which is not correct in common sense.
5. Regarding the standardization of the ELISA method for detecting ANA and ds-DNA.
My crude understanding is only in terms of the reference value corresponding to the reagents taken by the local laboratory. The reagents from different reagent companies are not comparable between different laboratories. We can continue to discuss this issue.
6. On the issue of classification conditions.
My understanding is that any one of the two aspects can be classified as SLE, rather than to de-emphasize the importance of kidney biopsy. For example: 1. biopsy-proven lupus nephritis with positive ANA or positive anti-ds-DNA; 2. the patient meets 4 of the classification criteria, including at least one clinical criterion and one immunological criterion. This actually simplifies the diagnostic procedure, for example, the first condition, after biopsy confirmation, can be classified as SLE as long as there are anti-nuclear antibodies or ds-DNA positivity.