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Aktuelle Rheumatologie 2020; 45(04): 299-306
DOI: 10.1055/a-1165-1725
Übersichtsarbeit

Neue Klassifikationskriterien des SLE: was helfen sie für die klinische Diagnose des SLE?

New Classification Criteria for SLE: Can they Help in Clinical Diagnosis?
Martin Aringer
1   Department of Medicine III, Division of Rheumatology, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden
,
Kristin Wiefel
1   Department of Medicine III, Division of Rheumatology, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden
,
Nicolai Leuchten
1   Department of Medicine III, Division of Rheumatology, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden
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Zusammenfassung

Im September 2019 sind die gemeinsamen Klassifikationskriterien der European League Against Rheumatism (EULAR) und des American College of Rheumatology (ACR) für den systemischen Lupus erythematodes (SLE) erschienen. Die EULAR/ACR 2019 Klassifikationskriterien verwenden (jemals) positive antinukleäre Antikörper (ANA) als obligates Eingangskriterium und gewichtete Kriterien mit Werten von 2 bis 10 und einem Cut-off von 10. Die Kriterien sind in 10 Domänen geordnet, innerhalb derer Assoziationen zwischen verschiedenen Manifestationen bestehen, und nur der höchste Wert in einer Domäne wird verwendet. Kriterien werden nur gewertet, wenn es für sie keine andere Erklärung gibt, die wahrscheinlicher ist als der SLE. Die neuen Kriterien sind statistisch den älteren Kriteriensets überlegen. Sie gelten aber nur für die Klassifikation. Für die meisten Rheumatologinnen und Rheumatologen ist das Stellen der Diagnose eines SLE wesentlich relevanter als der Einschluss in SLE-Studien, für den die Klassifikationskriterien gedacht sind. Daher stellt sich die Frage, wie weit die Klassifikationskriterien für die Diagnose helfen können. Direkt dafür verwendet werden dürfen sie wirklich nicht. Erfahrene Ärztinnen und Ärzte sind besser und v. a. sensitiver als die besten Kriterien. Manche Detailinformationen helfen aber dennoch dabei, die individuelle Diagnose für konkret Patientinnen und Patienten zu stellen. Die vorliegende Arbeit erörtert die Neuigkeiten in den EULAR/ACR 2019-Kriterien, stellt den Unterschied zwischen Klassifikation und Diagnose dar und diskutiert, welche Informationen auch im klinischen Alltag Anwendung finden können.

Abstract

In September 2019, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) published their joint classification criteria for systematic lupus erythematosus (SLE). The EULAR/ACR 2019 classification criteria use positive antinuclear antibodies (ANA) as a mandatory entry criterion and weighted criteria with values from 2 to 10 and a cut-off of 10. The criteria are arranged in ten domains, within which associations between different manifestations exist, and only the highest value in a domain is used. Criteria are only counted if there is no other explanation for them that is more likely than SLE. The new criteria are statistically superior to the older sets of criteria. However, they only apply to classification. For most rheumatologists, making a diagnosis of SLE is much more relevant than inclusion in SLE studies, for which the classification criteria are intended. This gives rise to the question of the extent to which the classification criteria can help in the diagnosis. They must not be used directly for this purpose. Experienced physicians are better and, above all, more sensitive than the best criteria. Nevertheless, some detailed information can help to make an individual diagnosis for specific patients. This paper discusses updates in the EULAR/ACR 2019 criteria, presents the difference between classification and diagnosis and discusses the information that can be used for everyday clinical practice.

Schlüsselwörter

systemic lupus erythematosus - classification criteria - diagnosis - fever

Key words

Klassifikationskriterien - Diagnose - Fieber - Systemischer Lupus erythematodes


Publication History

Article published online:
25 May 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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