APR: Systemic Lupus Erythematosus Save

Dr. Cush, would you really have us go back 40 years–to SLE criteria that had 83% sensitivity (less for atypical disease), while 2019 EULAR/ACR criteria have 96% sensitivity–just because you have a bad memory? You don't have to remember the point system. Use the SLE App.

A paradigm shift has happened in SLE since 1987. Please don't drag the diagnostic process back to a time when early disease and late-onset disease were missed and no one knew any better. This is STILL happening because clinical practitioners are clinging to outdated criteria they were trained on. This leads to misdiagnosis, missed diagnosis, and delayed diagnosis–ultimately leading to diagnostic failure and untreated disease progression for patients. This is not progress.

Late-onset SLE (onset after age 50; comprising up to 20% of SLE patients) barely gets a mention here. The phenotype is well-recognized and should be highlighted for new practitioners: 1) more prevalent in Caucasians; 2) fewer classic skin symptoms; 3) less remarkable antibody profiles; 4) higher prevalence of aPL; 5) more serositis; and 6) lower disease activity, despite higher morbidity and organ damage. Use 2019 criteria to identify it!