Subscribe to RSS
DOI: 10.1055/a-1970-6301
The value of 2019 EULAR/ACR classification criteria in predicting lupus nephritis in childhood-onset systemic lupus erythematosus
Der Wert der EULAR/ACR-Klassifizierungskriterien von 2019 bei der Vorhersage des Auftretens von Lupusnephritis bei Patienten mit systemischem Lupus erythematodes mit Beginn im Kindesalter![](https://www.thieme-connect.de/media/klinpaed/202305/lookinside/thumbnails/1623_10-1055-a-1970-6301-1.jpg)
Abstract
Background We investigated the role of European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for the prediction of LN among children with SLE.
Methods The data of the patients with childhood-onset SLE diagnosed based on 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria were retrospectively evaluated. Based on 2019 EULAR/ACR classification criteria, the scoring was done at the time of renal biopsy.
Results Fifty-two patients (12 with LN, 40 without LN) were included. The mean score was higher in patients with LN than those without (30.8±6.14, 19.8±7.76, respectively, p=0.000). The score value had indicative value for LN (area under curve [AUC]:0.863±0.055, cut-off value:22.5, p=0.000). Lymphocyte counts had a predictive value for LN (cut-off value:905/mm3, AUC:0.688±0.087, p=0.042). The score was positively associated with SLE disease activity index (SLEDAI) and activity index (r=0.879, p=0.000; r=0.811, p=0.001, respectively). There were significant negative associations between score value and GFR (r=-0.582, p=0.047). The patients with renal flare had higher the mean score than those of without renal flare (35±2/25.4±5.57, respectively, p=0.019).
Conclusions The EULAR/ACR criteria score could reflect the activity of disease and severity of nephritis in childhood-onset SLE. A point of 22.5 as score value might be an indicator for LN. During scoring, it should be taken into account that lymphopenia might guide the prediction of LN.
Zusammenfassung
Hintergrund Wir untersuchten die Rolle der Klassifizierungskriterien der European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) für die Vorhersage von LN bei Kindern mit SLE.
Methoden Es erfolgte eine retrospektive Auswertung der Daten von Patienten mit SLE im Kindesalter, deren Erkrankung anhand der Kriterien der Systemic Lupus International Collaborating Clinics (SLICC) von 2012 diagnostiziert wurde. Basierend auf den EULAR/ACR-Klassifizierungskriterien von 2019 wurde eine Beurteilung mittels Score zum Zeitpunkt der Nierenbiopsie durchgeführt.
Ergebnisse 52 Patienten (12 mit LN, 40 ohne LN) wurden eingeschlossen. Der Mittelwert war bei Patienten mit LN höher als bei Patienten ohne LN (30,8±6,14 bzw. 19,8±7,76, p=0,000). Der Score-Wert hatte einen indikativen Wert für LN (Fläche unter der Kurve [AUC]: 0,863±0,055, Grenzwert: 22,5, p=0,000). Die Anzahl der Lymphozyten hatte einen prädiktiven Wert für LN (Grenzwert: 905/mm3, AUC: 0,688±0,087, p=0,042). Der Score korrelierte positiv mit der SLE-Krankheitsaktivität (r=0,879, p=0,000; r=0,811, p=0,001). Es gab signifikante negative Korrelationen zwischen dem Score-Wert und der GFR (r=−0,582, p=0,047). Die Patienten mit akutem Schub der Nephritis hatten einen höheren Mittelwert als die Patienten ohne akuten Schub (35±2 / 25,4±5,57, p=0,019).
Schlussfolgerungen Der EULAR/ACR-Kriterien-Score könnte die Krankheitsaktivität und den Schweregrad der Nephritis bei SLE mit Beginn im Kindesalter widerspiegeln. Eine Punktzahl von 22,5 als Score-Wert könnte ein Indikator für LN sein. Bei der Score-Beurteilung sollte berücksichtigt werden, dass eine Lymphopenie bei der Vorhersage von LN als Orientierungshilfe dienen kann.
Key words
Lupus nephritis - 2019 EULAR/ACR classification criteria - children - systemic lupus erythematosusSchlüsselwörter
Lupus nephritis - EULAR/ACR-Klassifikations kriterien 2019 - Kinder - systemischer lupus erythematodesPublication History
Article published online:
29 March 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart,
Germany
-
References
- 1 Abdwani R, Al Masroori E, Abdullah E. et al. Evaluating the performance of ACR, SLICC and EULAR/ACR classification criteria in childhood onset systemic lupus erythematosus. Pediatr Rheumatol Online J 2021; 19: 141
- 2 Aljaberi N, Nguyen K, Strahle C. et al. The performance of the new 2019-EULAR/ACR classification criteria for systemic lupus erythematosus in children and young adults. Arthritis Care Res 2020; 73: 580-585
- 3 Aringer M, Costenbader K, Daikh D. et al. European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis 2019; 78: 1151-1159
- 4 Bajema IM, Wilhelmus S, Alpers CE. et al. Revision of the international society of nephrology/renal pathology society classification for lupus nephritis: clarification of definitions, and modified national institutes ofhealth activity and chronicity indices. Kidney Int 2018; 93: 789-796
- 5 Bertsias GK, Tektonidou M, Amoura Z. et al. Joint European League Against Rheumatism and European Renal Association European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis 2012; 71: 1771-1782
- 6 En-Nasri S, Fouad Z, Fadili W. et al. Lupus nephritis: frequency, histological forms and predictors of renal disease. La Tunisie Medicale 2014; 92: 626-630
- 7 Fanouriakis A, Kostopoulou M, Alunno A. et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis 2019; 736-745
- 8 Fonseca AR, Rodrigues MCF, Sztajnbok FR. et al. Comparison among ACR1997, SLICC and the new EULAR/ACR classification criteria in childhood-onset systemic lupus erythematosus. Adv Rheumatol 2019; 59: 20
- 9 Gladman DD, Urowitz MB, Goldsmith CH. et al. The reliability of the Systemic Lupus Erythematosus International Collaborating Clinics/American College of Rheumatology Damage Index in patients with systemic lupus erythematosus. Arthritis Rheum 1997; 40: 809-813
- 10 Gladman DD, Ibañez D, Urowitz MB.. Systemic lupus erythematosus disease activity index 200. J Rheumatol 2002; 29: 288-291
- 11 Gibson KL, Gipson DS, Massengill SA. et al. Predictors of relapse and end stage kidney disease in proliferative lupus nephritis: focus on children, adolescents, and young adults. Clin J Am Soc Nephrol 2009; 4: 1962-1967
- 12 Hahn BH, McMahon MA, Wilkinson A. et al. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res 2012; 64: 797-808
- 13 Lee BS, Cho HY, Kim EJ. et al. Clinical outcomes of childhood lupus nephritis: A single center's experience. Pediatr Nephrol 2007; 22: 222-231
- 14 Levy DM, Kamphuis S.. Systemic lupus erythematosus in children and adolescents. Pediatr Clin North Am 2012; 59: 345-364
- 15 Livingston B, Bonner A, Pope J.. Differences in clinical manifestations between childhood-onset lupus and adult-onset lupus: a meta-analysis. Lupus 2011; 20: 1345-1355
- 16 Maddison PJ, Provost TT, Reichlin M.. Serological findings in patients with “ANA-negative” systemic lupus erythematosus. Medicine 1981; 60: 87-94
- 17 Mina R, Brunner HI.. Update on differences between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Res Ther 2013; 15: 218
- 18 Papadimitraki ED, Isenberg DA.. Childhood and adult-onset lupus: An update of similarities and differences. Expert Rev Clin Immunol 2009; 5: 391-403
- 19 Petri M, Orbai AM, Alarco’n GS. et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64: 2677-2686
- 20 Punaro MG.. The treatment of systemic lupus proliferative nephritis. Pediatr Nephrol 2013; 28: 2069-2078
- 21 Silva CA.. Childhood-onset systemic lupus erythematosus: early disease manifestations that the paediatrician must know. Expert Rev Clin Immunol 2016; 12: 907-910
- 22 Smith EMD, Rasul S, Ciurtin C. et al. Limited sensitivity and specificity of the ACR/EULAR-2019 classification criteria for SLE in JSLE?-observations from the UK JSLE Cohort Study. Rheumatology (Oxford) 2021; 60: 5271-5281
- 23 Suda M, Kishimoto M, Ohde S. et al. Validation of the 2019 ACR/EULAR classification criteria of systemic lupus erythematosus in 100 Japanese patients: a real-world setting analysis. Clin Rheumatol 2020; 39: 1823-1827
- 24 Tsokos GC.. Systemic lupus erythematosus. N Engl J Med 2011; 365: 2110-2121
- 25 Tucker LB, Uribe AG, Fernandez M. et al. Adolescent onset of lupus results in more aggressive disease and worse outcomes: results of a nested matched case-control study within LUMINA, a multiethnic US cohort (LUMINA LVII). Lupus 2008; 17: 314-322
- 26 Wang H, Gao Y, Ma Y. et al. Performance of the 2019 EULAR/ACR systemic lupus erythematosus classification criteria in a cohort of patients with biopsy-confirmed lupus nephritis. Lupus Science & Medicine 2021; 8: e000458
- 27 Tanha N, Hansen RB, Nielsen CT. et al. Clinical and serological associations with the development of incident proteinuria in Danish patients with systemic lupus erythematosus. J Rheumatol 2018; 45: 934-941
- 28 Watson L, Leone V, Pilkington C. et al. Disease activity, severity, and damage in the UK Juvenile-Onset Systemic Lupus Erythematosus Cohort. Arthritis Rheum 2012; 64: 2356-2365
- 29 Weening JJ, D’agati VD, Schwartz MM. et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 2004; 65: 521-530
- 30 Zhang CX, Cai L, Zhou ZY. et al. Clinical manifestations, immunological features and prognosis of Chinese pediatric systemic lupus erythematosus: A singlecenter study. Int J Rheum Dis 2019; 22: 1070-1076