Rheumatology A

ACR/EULAR SLE Classification Criteria 2019

2019 EULAR/ACR classification criteria for SLE: positive ANA (entry criterion), then weighted criteria in 7 clinical and 3 immunology domains — only the highest criterion in each domain counts. At least one clinical criterion and 10 or more points classify SLE. Count a criterion only if nothing explains it better than SLE; criteria need not occur at the same time.

ANA ≥ 1:80 on HEp-2 cells (or an equivalent positive test) at least once — entry criterion*

Constitutional: fever > 38.3 °C*

Haematological (highest that applies)*

Neuropsychiatric (highest that applies)*

Mucocutaneous (highest that applies)*

Serosal (highest that applies)*

Musculoskeletal: joint involvement*

Renal (highest that applies)*

Antiphospholipid antibodies: anticardiolipin at medium or high titre (> 40 units or > 99th centile), anti-β2GPI, or lupus anticoagulant*

Immunology: Low C3 and/or C4*

SLE-specific antibodies: anti-dsDNA (assay ≥ 90% specific for SLE) or anti-Sm*

Score interpretation

Not Classified — No Clinical Criterion -2

The criteria need at least one clinical criterion (constitutional, haematological, neuropsychiatric, mucocutaneous, serosal, musculoskeletal or renal); immunology alone does not classify SLE.

→ Follow up ANA-positive patients with SLE-specific antibodies; rheumatology opinion if clinical suspicion.

Not Classifiable — ANA Entry Criterion Not Met -1

Without ANA ≥ 1:80 at least once, the 2019 criteria cannot classify SLE.

→ Repeat ANA (HEp-2) if clinical suspicion; consider other connective tissue diseases; rheumatology opinion.

SLE Not Classified 0–9

Score <10: Does not meet 2019 ACR/EULAR classification for SLE

→ Consider other connective tissue diseases; follow up ANA-positive patients; rheumatology opinion if clinical suspicion

SLE Classified 10–51

Score ≥10: Meets 2019 ACR/EULAR criteria for SLE (requires positive ANA)

→ Rheumatology referral; baseline renal function, urinalysis, complement, anti-dsDNA; consider hydroxychloroquine; organise organ-specific investigations

Interpretation bands for the SLE Criteria 2019. Apply clinical judgement and local guidance.

References

Aringer M, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol. 2019;71(9):1400-1412.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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