SLICC Criteria for Systemic Lupus Erythematosus (SLE) Diagnosis
Helps diagnose Systemic Lupus Erythematosus based on lupus nephritis, clinical and immunological symptoms.
Refer to the text below the calculator for more information about the original study and validation of the SLICC criteria.
The new Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria for the diagnosis of Systemic Lupus Erythematosus was brought to improve the performance of SLE diagnosis, over the American College of Rheumatology (ACR) 1997 criteria.
Please also note that the criteria is cumulative, meaning that historic and current findings need not be present concurrently to meet the positive diagnosis.
Systemic Lupus Erythematosus (SLE) diagnosis is positive if:
Patient has biopsy-proven nephritis compatible with SLE and Antinuclear antibody (ANA) or anti-dsDNA antibodies.
OR
Patient has at least 4 of clinical and immunological criteria (with at least 1 clinical and one immunological).
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SLICC Criteria for Systemic Lupus Erythematosus (SLE)
The new Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria for the diagnosis of Systemic Lupus Erythematosus was brought to improve the performance of SLE diagnosis, over the American College of Rheumatology (ACR) 1997 criteria.
Systemic Lupus Erythematosus (SLE) diagnosis is positive if both are present:
- Biopsy-proven nephritis compatible with SLE;
- Antinuclear antibody (ANA) or anti-dsDNA antibodies;
OR
- Patient has at least 4 of clinical and immunological criteria (with at least 1 clinical and one immunological).
The table below summarizes the clinical and immunological criteria from the SLICC 2012:
| Clinical criteria | Immunological criteria |
| Acute cutaneous lupus - Lupus malar rash (not malar discoid), bullous lupus, toxic epidermal necrolysis variant of SLE, maculopapular lupus rash, photosensitive lupus rash (not dermatomyositis), subacute cutaneous lupus (nonindurated psoriasiform and/or annular polycyclic lesions that resolve without scarring, although occasionally with postinflammatory dyspigmentation or telangiectasias) | ANA above laboratory reference range |
| Chronic cutaneous lupus - Localized (above the neck) and/or generalized (above and below the neck) classical discoid rash, hypertrophic (verrucous) lupus, lupus panniculitis (profundus), mucosal lupus, lupus erythematosus tumidus, chilblains lupus, discoid lupus/lichen planus overlap | Anti-dsDNA above laboratory reference range, except ELISA (2x above laboratory reference range) |
| Oral ulcers - Palate, buccal, tongue, or nasal ulcers; in absence of other causes | Anti-Sm |
| Nonscarring alopecia - in absence of other causes | Antiphospholipid antibody - Lupus anticoagulant, false positive RPR, medium or high titer anticardiolipin (IgA, IgG, or IgM), anti-β₂ glycoprotein (IgA, IgG, or IgM) |
| Synovitis - Involving ≥2 joints, characterized by swelling or effusion OR tenderness in ≥2 joints and 30 mins or more of morning stiffness | Low complement - low C3, low C4, low CH50 |
| Serositis - Typical pleurisy for >1 day, pleural effusions, or pleural rub, typical pericardial pain for >1 day, pericardial effusion, pericardial rub, or pericarditis by EKG (in absence of other causes) | Positive direct Coombs test - in the absence of hemolytic anemia |
| Renal - Urine protein/creatinine (or 24 hr urine protein) representing 500 mg of protein/24 hr, RBC casts | - |
| Neurologic - Seizures, psychosis, mononeuritis multiplex (in absence of other causes), myelitis, peripheral or cranial neuropathy (in absence of other causes), acute confusional state (in absence of other causes) | - |
| Hemolytic anemia - in absence of other causes | - |
| Leukopenia or lymphopenia: <4,000/mm³ at least once (leukopenia) or <1,000/mm³ at least once (lymphopenia); in absence of other causes | - |
| Thrombocytopenia: <100,000/mm³ at least once; in absence of other causes | - |
Please also note that the criteria is cumulative, meaning that historic and current findings need not be present concurrently to meet the positive diagnosis.
The original study by Petri and Orbai et al. derived the classification criteria from a set of 702 expert rated patient scenarios and validated it in a sample of 690 new expert rated patient scenarios.
In both the derivation and validation sets, the SLICC 2012 classification criteria resulted in fewer misclassifications compared with the current ACR 1997 classification criteria.
A validation study by Inês et al. compared the sensitivity for SLE classification between the ACR and SLICC criteria in a multicenter, international population of 2,055 patients. The sensitivity of the 2 classification sets was compared using McNemar's test.
The sensitivity for SLE classification was higher with the SLICC than with the ACR (93.2% versus 85.6%; P < 0.0001).
Also, in the cases of 296 patients not fulfilling the ACR, 62.8% of them could be classified with the SLICC. Overall, the validation study found that the SLICC is not only more sensitive but could also allow patients to be classified as having SLE earlier in the disease course.
References
Original reference
Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012; 64(8):2677-2686.
Validation
Inês L, Silva C, Galindo M, et al. Classification of Systemic Lupus Erythematosus: Systemic Lupus International Collaborating Clinics Versus American College of Rheumatology Criteria. A Comparative Study of 2,055 Patients From a Real-Life, International Systemic Lupus Erythematosus Cohort. Arthritis Care Res (Hoboken). 2015; 67(8):1180-1185.
Other references
Amezcua-Guerra LM, Higuera-Ortiz V, Arteaga-García U, Gallegos-Nava S, Hübbe-Tena C. Performance of the 2012 Systemic Lupus International Collaborating Clinics and the 1997 American College of Rheumatology classification criteria for systemic lupus erythematosus in a real-life scenario. Arthritis Care Res (Hoboken). 2015; 67(3):437-441.
Tiao J, Feng R, Carr K, Okawa J, Werth VP. Using the American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria to determine the diagnosis of systemic lupus erythematosus (SLE) in patients with subacute cutaneous lupus erythematosus (SCLE). J Am Acad Dermatol. 2016; 74(5):862-869.
Specialty: Disability
System: Diagnosis
Year Of Study: 2012
Abbreviation: SLICC
Article By: Denise Nedea
Published On: September 1, 2020 · 12:00 AM
Last Checked: September 1, 2020
Next Review: September 1, 2025