Eular criteria for SLE
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EULAR/ACR 2019 Classification Criteria for SLE
The 2019 EULAR/ACR classification criteria for Systemic Lupus Erythematosus replaced the older 1997 ACR and 2012 SLICC criteria, with improved sensitivity and specificity.
Entry Criterion (Mandatory)
ANA titer ≥1:80 on HEp-2 cells (or equivalent positive test) at least once. If negative, do not classify as SLE. If positive, proceed to additive criteria.
Additive Criteria
Criteria are only counted if not better explained by another cause. Only the highest-weighted criterion within each domain is counted (you don't sum sub-items in the same domain, just take the highest scorer per domain). A patient is classified as SLE if they have the entry criterion plus a total score ≥10, with at least one clinical criterion present.
Clinical Domains (with weights)
Constitutional
- Fever: 2
Hematologic
- Leukopenia: 3
- Thrombocytopenia: 4
- Autoimmune hemolysis: 4
Neuropsychiatric
- Delirium: 2
- Psychosis: 3
- Seizure: 5
Mucocutaneous
- Non-scarring alopecia: 2
- Oral ulcers: 2
- Subacute cutaneous or discoid lupus: 4
- Acute cutaneous lupus: 6
Serosal
- Pleural or pericardial effusion: 5
- Acute pericarditis: 6
Musculoskeletal
- Joint involvement (synovitis in ≥2 joints or tenderness in ≥2 joints plus ≥30 min morning stiffness): 6
Renal
- Proteinuria >0.5 g/24h: 4
- Renal biopsy showing Class II or V lupus nephritis: 8
- Renal biopsy showing Class III or IV lupus nephritis: 10
Immunologic Domains (with weights)
Antiphospholipid antibodies
- Anticardiolipin, or anti-β2GP1, or lupus anticoagulant: 2
Complement proteins
- Low C3 OR low C4: 3
- Low C3 AND low C4: 4
Highly specific antibodies
- Anti-dsDNA (in an assay with ≥90% specificity), or anti-Smith: 6
Key Points
- Sensitivity ~96%, specificity ~93% (better than the 1997 ACR criteria).
- Designed for classification in research/clinical trial settings, not strictly for individual diagnosis - clinical judgment still governs actual patient diagnosis.
- Renal biopsy findings alone (Class III/IV, weight 10) combined with a positive ANA can meet the ≥10 threshold even without other clinical features - but remember at least one clinical criterion must be present, and biopsy-proven nephritis itself counts as the clinical (renal) criterion.
Let me know if you want a comparison against the 2012 SLICC or 1997 ACR criteria, or a walk-through of how to apply these weights to a specific case.
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