|New Classification Criteria Developed For Scleroderma|
|Monday, 07 October 2013 09:37|
The 2013 Classification Criteria for Systemic Sclerosis have been developed and validated by the American College of Rheumatology and EULAR and should allow patients to be identified and treated earlier, according to the professional bodies.
Published in Arthritis and Rheumatism, the new criteria will classify patients as having Systemic Sclerosis if they have thickening of the skin in the middle part of the fingers (from the proximal to the metacarpophalangeal joints) regardless of other features.
A further seven features need to be assessed to make a Scleroderma classification if this criterion is not met. These features include skin thickening of the fingers, fingertip lesions, telangiectasia, abnormal nailfold capillaries, pulmonary arterial hypertension and interstitial lung disease, Raynaud’s phenomenon and Systemic Sclerosis-related antibodies.
However, several items that are useful for recognising Systemic Sclerosis in clinical practice, such as Calcinosis, flexion contractures of the fingers, tendon or bursal friction rubs, oesophageal dilatation and dysphagia were not included in the criteria because they did not improve sensitivity or specificity.
According to the authors of the new classification system, the 1980 ACR criteria for systemic sclerosis were updated by clustering items and simplifying the weighting of the different criteria. “The 1980 ACR criteria were not sensitive enough to identify patients with early disease or limited cutaneous System Sclerosis,” said co-author Dr Frank van den Hoogen from the Netherlands.
When validated by comparing with non-scleroderma control cases, the new criteria proved to have a sensitivity of 0.91 and specificity of 0.92, whereas the old ACR criteria had a sensitivity and specificity of 0.75 and 0.72 respectively. “The new classification criteria should correctly classify more patients with the disease,” said co-author Dr Janet Pope from Ontario.
“Criteria that are more specific will allow for earlier identification and better treatment for those with systemic sclerosis,” she said. The authors acknowledged that testing and validating the new criteria was difficult because there is no ‘gold standard’ to define a standard case of Systemic Sclerosis. The ACR-EULAR committee therefore had to rely on a consensus of expert opinion, with a focus on controversial cases.
“the ACR/EULAR classification criteria for systemic sclerosis perform better than the 1980 ACR preliminary criteria in terms of both sensitivity and specificity,” the authors conclude. They are relatively simple to apply in individual subjects [and] may be endorsed as inclusion criteria for systemic sclerosis studies,” they added
Source: Rheumatology Update (2013)