Pediatric emergency medicine trisk 2920 2920

Current Evidence
SLE is a multisystem disease that is both pleomorphic in its presentation and variable
in its clinical course. In many ways, it is the quintessential autoimmune disease, with
antibodies to cellular constituents causing immune-mediated attack on various organs,
including the skin, joints, peripheral and central nervous system, kidneys, and serosal
surfaces. In children, the disease is more severe, with a higher incidence of renal and
neurologic involvement.
The classification system for SLE was revised in 2012, reflecting a harmonization
between the newer criteria of the Systemic Lupus International Collaborating Clinics
(SLICC) group and the criteria of the American College of Rheumatology (ACR),
which had been the standard classification system for decades. Table 101.1 lists the
ACR criteria and the updated revised SLICC criteria and definitions. This newer
classification differs from the 1997 ACR criteria in two significant ways. First, the
SLICC criteria were expanded to include 17 individual elements, rather than 11, thus
greatly expanding the breadth of the diagnosis. Secondly, the diagnosis rests on the
presence of one immunologic criterion as well as the presence of at least one clinical
criterion, rather than the previous format that relied on only clinical symptoms in some
cases. The SLICC criteria have improved sensitivity (97%) but decreased specificity
(84%) when compared to the 1997 ACR criteria.