2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative
2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative
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DOI：
10.1136/annrheumdis-2013-204424
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发表时间：
2013-11-01
影响因子：
27.4
通讯作者：
Pope, Janet E.
中科院分区：
文献类型：
--
作者：
van den Hoogen, Frank;Khanna, Dinesh;Pope, Janet E.
目的1980年美国风湿病学会(ACR)对系统性硬化症(SSC)的分类标准对早期SSC和局限性皮肤SSC缺乏敏感性。这项工作由ACR和欧洲抗风湿病联盟(EULAR)组成的联合委员会进行，目的是制定新的SSC分类标准。方法采用协商一致的方法，将23个候选条目排列在多标准加分系统中，并设置阈值将病例归类为SSSC。通过对项目进行聚类和简化权重，简化了分类系统。该系统通过(1)在硬皮病样疾病患者和对照组中测定特异性和敏感性，以及(2)与一组有或没有SSc的专家的联合观点进行验证。结果确定延伸到掌指关节近端的手指皮肤增厚足以将患者归类为SSc；如果不存在，则适用7个附加项目，每个项目的权重不同：手指皮肤增厚、指尖病变、毛细血管扩张、异常甲皱毛细血管、间质性肺疾病或肺动脉高压、雷诺现象和SSC相关自身抗体。在验证样本中，新分类标准的敏感度和特异度分别为0.91和0.92,1980年ACR分类标准的敏感度和特异度分别为0.75和0.72。所有选定的案例都根据基于协商一致的专家意见进行了分类。结论ACR/EULAR的SSC分类标准优于1980年ACR的SSC分类标准，应允许更多的患者被正确地归类为SSC。
Objective The 1980 American College of Rheumatology (ACR) classification criteria for systemic sclerosis (SSc) lack sensitivity for early SSc and limited cutaneous SSc. The present work, by a joint committee of the ACR and the European League Against Rheumatism (EULAR), was undertaken for the purpose of developing new classification criteria for SSc.Methods Using consensus methods, 23 candidate items were arranged in a multicriteria additive point system with a threshold to classify cases as SSc. The classification system was reduced by clustering items and simplifying weights. The system was tested by (1) determining specificity and sensitivity in SSc cases and controls with scleroderma-like disorders, and (2) validating against the combined view of a group of experts on a set of cases with or without SSc.Results It was determined that skin thickening of the fingers extending proximal to the metacarpophalangeal joints is sufficient for the patient to be classified as having SSc; if that is not present, seven additive items apply, with varying weights for each: skin thickening of the fingers, fingertip lesions, telangiectasia, abnormal nailfold capillaries, interstitial lung disease or pulmonary arterial hypertension, Raynaud's phenomenon, and SSc-related autoantibodies. Sensitivity and specificity in the validation sample were, respectively, 0.91 and 0.92 for the new classification criteria and 0.75 and 0.72 for the 1980 ACR classification criteria. All selected cases were classified in accordance with consensus-based expert opinion. All cases classified as SSc according to the 1980 ACR criteria were classified as SSc with the new criteria, and several additional cases were now considered to be SSc.Conclusions The ACR/EULAR classification criteria for SSc performed better than the 1980 ACR criteria for SSc and should allow for more patients to be classified correctly as having the disease.