Validation of ACR and EULAR 2019 Classification Criteria for Lupus in Children

By :
    Estefanía Fajardo
    Periodista científica de Global Rheumatology by PANLAR.

13 August, 2021
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With a study group and a control group, the analysis was performed in children at the Federico Gómez Children's Hospital of Mexico, the first study of its kind in a Latin American pediatric population.




EF: Hello everyone, welcome to a new Global Rheumatology video blog where we will be doing a series of interviews to talk about these oral presentations that will be made at the PANLAR 2021 Congress. We are with Dr. Richard Loor, welcome doctor.


RL: Good evening, thank you for the invitation.


EF: Doctor, tell us what is this oral presentation that you are going to have, what is it about, what is the subject matter that you are dealing with in this research.


RL: Well, the title of the presentation is Validation of the 2019 European League Against Rheumatism and American College of Rheumatology classification criteria for systemic lupus erythematosus. 


This was performed in children at the Federico Gomez Children's Hospital of Mexico, so it is a study in which we first wanted to see the sensitivity, specificity, positive and negative predictive value of these new criteria that came out in 2019, and once we know these criteria, compare them with the two groups that we already have previously, such as the ACR criteria of 1997 and those of 2012, so that was the objective of the work that we performed.


EF: And what were the results of this comparison? 


RL: Well, the main results it yielded is that the most sensitive and most specific criteria are the new criteria, precisely the EULAR ACR 2019 criteria. Overall, it has a sensitivity of 98%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 98%, followed by the 1997 ACR criteria with a sensitivity of 91%, specificity of 98%, a positive predictive value of 98%, and a negative predictive value of 92%, and in last place was the 2012 criteria with a sensitivity of 88%, specificity of 97%, positive predictive value of 97% and a negative predictive value of 89%.


EF: To take this back to clinical practice, those who are seeing us and are being young rheumatologists or physicians who do not have a specialty in rheumatology, what could we tell them regarding this research and these results?


RL: Remember that basically all these three groups of criteria are classification criteria that should be used with caution and that the clinical criteria of the pediatric rheumatologist in this case will always take precedence over any classification group, but in patients who have doubts, who we think may have lupus, the criteria so far validated in the pediatric population are the 1997 ACR criteria; however, as our study is the first to be conducted in the Latin American pediatric population specifically, it shows that these new criteria basically have a better sensitivity and specificity.


So, this is the importance of the study, that we can be at the forefront of applying these new criteria and in this way our patients, our children, our adolescents, can benefit from an early diagnosis, so that they can be treated in a timely manner and avoid complications in the long run. 


EF: Precisely, you tell us that it is the first in Latin America, and how did the idea of carrying out this research and this study come about?


RL: It arises because once these new criteria are launched in 2019, it began as the largest cohort studied in adults, so being a pioneer of the Children's Hospital of Mexico we decided to apply them and to know how these criteria are, how they are applied in our pediatric population, so that's where this motivation to apply them comes from, and that is how we, having a fairly large population of children with lupus, took 100 children with lupus, who had already been diagnosed during the first month and we applied these criteria, and we compared them with 100 children who did not have any other disease, or rather, who had an autoimmune disease, who did not have lupus in order to be able to compare them. So, the first group was the case group, and the second group was the control group.


EF: Doctor, what is the invitation to those who are watching this interview, those who are watching this videoblog to enter the session and learn more about this research?


RL: I invite them to see the breakdown of each one of the criteria, the sensitivity and specificity of each one of them and that they can be motivated and also begin to apply these new criteria in each one of their countries; they can have their cohort and see how sensitive and specific it is in each one of the children that are working with them so that we can also apply them on a Latin American level, and why not, on a worldwide level. So, I invite you to listen, to see the results, and to be encouraged to attend all the talks, which are very good.


EF: Doctor, thank you very much for coming to this Global Rheumatology interview.


RL: Thank you very much for your invitation, we are looking forward to participating in the congress.

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