From the Guidelines
The diagnosis of Systemic Lupus Erythematosus (SLE) requires meeting the 2019 EULAR/ACR classification criteria, which use a scoring system where ≥10 points confirms SLE, with positive ANA as entry criterion 1. This criteria system constitutes a simple, direct, and precise classification method that can be easily implemented and even integrated in computer applications 1. The 2019 EULAR/ACR criteria assign points for constitutional symptoms, hematologic abnormalities, neuropsychiatric features, mucocutaneous lesions, serositis, musculoskeletal manifestations, renal involvement, and immunologic findings including anti-dsDNA, anti-Sm, and antiphospholipid antibodies 1. Some key points to consider in the diagnosis of SLE include:
- Non-correlation between methods used in anti-dsDNA determination may reflect differences in the antigenic specificity of the autoantibodies and in the antigens used as substrate 1
- Receiving relevant clinical information will help laboratories validate results and make valuable recommendations to diagnose and monitor the SLE patient 1
- Given the polyclonal character of the SLE autoimmune response, a 100% sensitive and specific diagnostic method may never be achieved 1
- Realistic and feasible objectives should be established, such as improving the cost-benefit ratio and applicability of available methods in broader populations, detecting more antigens, with reproducible results in different laboratories 1
- More studies are needed to improve the diagnostic value of anti-dsDNA assays in different populations 1 The use of anti-dsDNA autoantibodies is an important aspect of SLE diagnosis and follow-up, but it is not without controversy, and standardization of these assays is still lacking 1. Therefore, it is essential to use the 2019 EULAR/ACR classification criteria in conjunction with clinical judgment and laboratory results to diagnose and manage SLE patients effectively. In addition, clinicians should be aware of the limitations and potential inconsistencies of anti-dsDNA testing and consider these factors when interpreting results and making treatment decisions 1.
From the Research
Diagnostic Criteria for SLE
The diagnostic criteria for Systemic Lupus Erythematosus (SLE) are not well-established, and the disease remains largely a clinical diagnosis made after excluding alternative diagnoses 2.
Current Classification Criteria
Several sets of classification criteria are available, including the American College of Rheumatology (ACR) criteria and the Systemic Lupus International Collaborating Clinics (SLICC) criteria 3, 4. However, these criteria are not intended for diagnostic purposes and have limitations in terms of sensitivity and specificity 4.
Challenges in Diagnosis
The diagnosis of SLE can be challenging due to the multi-organ nature of the disease and the variability of its clinical manifestations 5, 2. The presence of antinuclear antibodies (ANA) and multiple immune-mediated organ symptoms are hallmarks of SLE, but these features can be independent and may not always be present simultaneously 5.
Proposed Solutions
Some studies propose interim potential solutions to facilitate the diagnosis of SLE, including the use of novel biomarkers and the development of new classification criteria 2, 4. However, more research is needed to establish reliable diagnostic criteria for SLE.
Key Features for Diagnosis
Some key features that may aid in the diagnosis of SLE include: