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ACR – EULAR Classification Criteria for Systemic Sclerosis

ACR – EULAR Classification Criteria for Systemic Sclerosis. May 25, 2013. Sindhu Johnson MD PhD . Learning Objectives. Highlight the limitations of pre-existing classification criteria To discuss the development of the new classification criteria

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ACR – EULAR Classification Criteria for Systemic Sclerosis

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  1. ACR – EULAR Classification Criteria for Systemic Sclerosis May 25, 2013 Sindhu Johnson MD PhD

  2. Learning Objectives Highlight the limitations of pre-existing classification criteria To discuss the development of the new classification criteria To discuss the application of the 2013 classification criteria

  3. Disclosures American College of Rheumatology Classification and Response Criteria Subcommittee of the Committee on Quality Measures.

  4. Co-convenors Janet Pope Frank van den Hoogen Members JaapFransen Sindhu Johnson Alan Tyndall Murray Baron Marco Matucci-Cerinic Dinesh Khanna Collaborators Ray Naden Christopher Denton Oliver Distler Armando Gabrielli Jaap van Laar Maureen Mayes Virginia Steen James Seibold Phillip Clements Thomas Medsger Gabriela Riemekasten Patricia Carreira Collaborators Lorinda Chung Barri Fessler Peter Merkel Richard Silver John Varga YannickAllanore Ulf Mueller-Ladner MadelonVonk Ulrich Walker Susanna Cappelli

  5. SSc diagnosis SSc classification

  6. ACR Preliminary Classification Criteria for Systemic Sclerosis Major criterion * Proximal scleroderma Minor criteria * Sclerodactyly * Digital pitting or scars or loss of substance from finger pad * Bibasilar pulmonary fibrosis Major criterion or 2 minor criteria Arthritis Rheum 1980; 23:581-90

  7. ACR Preliminary Classification Criteria for Systemic Sclerosis Sensitivity 97% of definite SSc cases Specificity 98% the comparison patients 1 major criterion or ≥ 2 minor criteria Arthritis Rheum 1980; 23:581-90

  8. Classificationschemes – Overview 1980 – American College ofRheumatology 1988 – LeRoy: lcSScanddcSSc 2001 – LeRoy: lSSc 1980 1990 2000 2010

  9. Limitations of ACR classificationcriteriaforSSc • LimitedcutaneousSSc • EarlySSc Miss subsets New knowledge Nailfold capillaries SSc- specific antibodies 20% SSc classification SSc diagnosis .

  10. Collaboration between experts and clinical epidemiologists Balance of expert based and data driven methods Avoid circularity of reasoning Evaluate psychometric properties of candidate criteria

  11. Classificationschemes – Overview 1980 – American College ofRheumatology 1988 – LeRoy: lcSScanddcSSc 2001 – LeRoy: lSSc Current: ACR-EULAR Collaboration 1980 1990 2000 2010

  12. Item Generation (Delphi panel) N = 168 Item Reduction (Delphi panel followed by Nominal Group Technique) N = 23 Consensus Method Evaluate validity of items in SSc and SSc mimickers Item reduction, weighting & scaling Data-Driven Method Collect prospective data in SSc and SSc mimickers Evaluate operating characteristics of SSc criteria

  13. Systemic Sclerosis YES YES EntryCriterion ExclusionCriteria Multi-CriteriaDecisionAnalysis AbsoluteCriteria ? meets “Threshold” NO YES NO Not Systemic Sclerosis

  14. Learning Objectives Highlight the limitations of pre-existing classification criteria To discuss the development of the new classification criteria To discuss the application of the 2013 classification criteria

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