Systemic Lupus Erythematosus

The American College of Rheumatology (ACR) classification criteria states that the presence of 4 or more of the following symptoms (in the absence of other causes for those symptoms) are indicative of a diganosis of Lupus.

Symptom	Criteria
1. Arthritis	Nonerosive Involving 2 or more peripheral joints, characterized by tenderness, swelling, or effusion
2. Malar Rash	Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds
3. Discoid Rash	Erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions
4. Photosensitivity	Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation
5. Oral Ulcers	Oral or nasopharyngeal ulceration, usually painless, observed by physician
6. Pleuritis or Pericarditis	Pleuritis – convincing history of pleuritic pain or rubbing heard by a physician or evidence of pleural effusion OR Pericarditis–documented by electrocardigram or rub or evidence of pericardial effusion
7. Renal Disorder	Persistent proteinuria > 0.5 grams per day or > than 3+ if quantitation not performed OR Cellular casts – may be red cell, hemoglobin, granular, tubular, or mixed
8. Neurological Disorder	Seizures–in the absence of offending drugs or known metabolic derangements; e.g., uremia, ketoacidosis, or electrolyte imbalance OR Psychosis–in the absence of offending drugs or known metabolic derangements, e.g., uremia, ketoacidosis, or electrolyte imbalance
9. Haematological	Haemolytic anemia – with reticulocytosis OR Leukopenia – < 4,000/mm3 on = 2 occasions OR Thrombocytopenia–<100,000/ mm3 in the absence of offending drugs
10. ANA Positive	An abnormal titer of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs
11. Immunological	Anti-DNA: antibody to native DNA in abnormal titer OR Anti-Sm: presence of antibody to Sm nuclear antigen OR Positive finding of antiphospholipid antibodies on: an abnormal serum level of IgG or IgM anticardiolipin antibodies, OR a positive test result for lupus anticoagulant using a standard method, or OR a false-positive test result for at least 6 months confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test

NOTE: Patients who do not completely fulfil the ACR criteria may be labelled as an UCTD (Undifferentiated Connective tissue Disorder) or lupus-like disorder. These patients require the same treatment as lupus dictated by the severity of the disease.

This information was derived from the 1997 update of the 1982 ACR classification criteria for SLE Arthritis Rheum 1997;40:1725. .