The American College of Rheumatology (ACR) modified its 1982 criteria for the diagnosis of systemic lupus erythematosus (SLE) in 1997.


Criteria (11)


malar rash

fixed erythema, flat or raised, over the malar eminences, sparing the nasolabial folds

discoid rash

erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur


skin rash as an unusual reaction to sunlight

oral ulcers

oral and nasopharyngeal.ulceration(s) observed by physician, usually painless


nonerosive arthritis involving 2 or more peripheral joints, characterized by tenderness, swelling or effusion


pleuritis or pericarditis, or evidence of pericardial effusion

renal disorder

persistent proteinuria (> 0.5 g/d, or > 3+) or cellular casts (red cell, hemoglobin, granular, tubular or mixed)

neurologic disorder

seizures without other cause or psychosis without other cause

hematologic disorder

hemolytic anemia with reticulocytosis, leukopenia (< 4,000 per µL on >= 2 occasions), lymphopenia (< 1,500 per µL on 2 or more occasions) or thrombocytopenia (< 100,000 per µL) in the absence of a causative drug

immunologic disorder

antibody to native DNA at an abnormal titer, anti-Sm antibodies, evidence of an antiphospholipid antibody (see below)

antinuclear antibodies

abnormal ANA titer at any point of time in the absence of drugs known to induce ANA


Differences from 1982 criteria:

(1) The positive LE cell preparation was deleted.

(2) The change of the immunologic disorder category "false positive VDRL" to positive for antiphospholipid antibodes based on (a) IgM or IgG anticardiolipin antibodies, (b) lupus anticoagulant OR (c) false-positive serologic test for syphilis. The false-positive serologic test for syphilis should be present for >= 6 months and by negative testing by a specific anti-Treponema pallidum test.




4 of 11 criteria at any time

SLE (98% specific)

3 criteria and clinical judgement

probable SLE

negative ANA

low probability of SLE (but can occur)

positive ANA alone (no organ involvement or other laboratory test abnormalities)

very low probability of SLE


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