Clinical Characteristics and Management of Patients With Clinical Amyopathic Dermatomyositis: A Retrospective Study of 64 Patients at a Tertiary Dermatology Department

Background: Clinical amyopathic dermatomyositis (CADM) represents a subtype of 5–20% of patients with dermatomyositis (DM), which can be categorized into amyopathic dermatomyositis (ADM) and hypomyopathic dermatomyositis (HDM). The characteristics of patients with CADM are still limited in English literature.Objective: To investigate clinical features, cutaneous findings, diagnostic accuracy, and treatment regimen of CADM patients.Methods: Sixty-four patients diagnosed with CADM at Peking Union Medical College Hospital by dermatologists were retrospectively analyzed. Data were recorded in the electronic database at each offline clinical consultation and directly extracted from medical records. 2017 EULAR/ACR criteria for idiopathic inflammatory myositis (IIM) classification was used to identify and classify patients with CADM. Published studies were searched to extract relevant data of CADM patients.Results: This cohort included 38 ADM patients and 26 HDM patients. 2017 EULAR/ACR criteria classified 67.2% of patients with CADM into probable or definite DM. Antimalarials were given to a majority of CADM patients (72.6%, n = 45). However, 68.8% (31 out of 45) required at least one aggressive agent combined with hydroxychloroquine due to insufficient response or side effects. The median of systemic treatments in HDM was significantly higher than ADM (p = 0.007). The number of ADM patients using antimalarials as monotherapy was significantly higher than that of HDM patients (p = 0.031), while the number of HDM patients receiving steroids combined with immunosuppressants was significantly higher (p = 0.025). The median of Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) score improvement was 11.5 and 10.5 for ADM and HDM after a median follow-up of 31.5 and 32.5 months, respectively. Six patients with normal muscle strength developed muscle weakness after a median of 10.5 months (IQR 9-13), and elevated inflammatory markers at initial visit might indicate their muscle weakness development.Conclusions: 32.8% of patients may be overlooked using the three skin variables of 2017 EULAR/ACR criteria. The response rate to single hydroxychloroquine in our cohort was 68.8%. Detailed treatment modalities were different among ADM and HDM. Long-term monitoring for the development of myositis in patients with CADM, especially those with elevated inflammatory markers at initial visit, may be warranted.

Upadacitinib in patients with psoriatic arthritis and an inadequate response to non-biological therapy: 56-week data from the phase 3 SELECT-PsA 1 study

BackgroundIn SELECT-PsA 1, a randomised double-blind phase 3 study, upadacitinib 15 mg and 30 mg were superior to placebo and non-inferior to adalimumab in ≥20% improvement in American College of Rheumatology (ACR) criteria at 12 weeks in patients with psoriatic arthritis (PsA). Here, we report 56-week efficacy and safety in patients from SELECT-PsA 1.MethodsPatients received upadacitinib 15 mg or 30 mg once daily, adalimumab 40 mg every other week for 56 weeks or placebo through week 24 switched thereafter to upadacitinib 15 mg or 30 mg until week 56. Efficacy endpoints included the proportion of patients achieving ≥20%/50%/70% improvement in ACR criteria (ACR20/50/70), ≥75%/90%/100% improvement in Psoriasis Area and Severity Index (PASI75/90/100), minimal disease activity (MDA) and change from baseline in modified total Sharp/van der Heijde Score. Treatment-emergent adverse events per 100 patient years (PY) were summarised.ResultsConsistent with results through week 24, ACR20/50/70, PASI75/90/100 and MDA responses were maintained with upadacitinib through week 56 and were generally numerically higher than with adalimumab; inhibition of radiographic progression was also maintained. Patients who switched from placebo to upadacitinib exhibited comparable improvements at week 56 as patients originally randomised to upadacitinib. The rates of serious adverse events were 9.1 events/100 PY with upadacitinib 15 mg and 12.3 events/100 PY with upadacitinib 30 mg. Two deaths were reported in each of the upadacitinib groups.ConclusionEfficacy across various domains of PsA were maintained with upadacitinib 15 mg and 30 mg through week 56 with no new safety signals observed.

POS0706 PERFORMANCES OF DIFFERENT CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS IN A SINGLE CENTER COHORT FROM TURKEY

Background:Recently developed EULAR/ACR classification criteria for systemic lupus erythematosus (SLE) have important differences compared to the 2012 Systemic Lupus International Collaborating Clinics (SLICC) SLE classification criteria and the revised 1997 American College of Rheumatology (ACR) criteria: The obligatory entry criterion of antinuclear antibody (ANA) positivity is introduced and a “weighted” approach is used1. Sensitivity and specificity of these three criteria have been debated and may vary in different populations and clinical settings.Objectives:We aim to compare the performances of three criteria sets/rules in a large cohort of patients and relevant diseased controls from a reference center with dedicated clinics for SLE and other autoimmune/inflammatory connective tissue diseases from Turkey.Methods:We reviewed the medical records of SLE patients and diseased controls for clinical and laboratory features relevant to all sets of criteria. Criteria sets/rules were analysed based on sensitivity, positive predictive value, specificity and negative predictive value, using clinical diagnosis with at least 6 months of follow-up as the gold standard. A subgroup analysis was performed in ANA positive patients for both SLE patients and diseased controls. SLE patients that did not fulfil 2012 SLICC criteria and 2019 EULAR/ACR criteria and diseased controls that fulfilled these criteria were evaluated.Results:A total of 392 SLE patients and 294 non-SLE diseased controls (48 undifferentiated connective tissue disease, 51 Sjögren’s syndrome, 43 idiopathic inflammatory myopathy, 50 systemic sclerosis, 52 primary antiphospholipid syndrome, 15 rheumatoid arthritis, 15 psoriatic arthritis and 20 ANCA associated vasculitis) were included into the study. Hundred and fourteen patients (16.6%) were ANA negative.Sensitivity was more than 90% for 2012 SLICC criteria and 2019 EULAR/ACR criteria and positive predictive value was more than 90% for all three criteria (Table 1). Specificity was the highest for 1997 ACR criteria. Negative predictive value was 76.9% for ACR criteria, 88.4% for SLICC criteria and 91.7% for EULAR/ACR criteria.In only ANA positive patients, sensitivity was 79.6% for 1997 ACR criteria, 92.2% for 2012 SLICC criteria and 96.1% for 2019 EULAR/ACR criteria. Specificity was 92.6% for ACR criteria, 87.8% for SLICC criteria 85.2% for EULAR/ACR criteria.Eleven clinically diagnosed SLE patients had insufficient number of items for both 2012 SLICC and 2019 EULAR/ACR criteria. Both criteria were fulfilled by 16 diseased controls: 9 with Sjögren’s syndrome, 5 with antiphospholipid syndrome, one with dermatomyositis and one with systemic sclerosis.Table 1.Sensitivity, positive predictive value, specificity and negative predictive value of 1997 ACR, 2012 SLICC and 2019 EULAR/ACR classification criteriaSLE (+)SLE (-)Sensitivity (%)Positive Predictive Value (%)Specificity (%)Negative Predictive Value (%)1997 ACR(+) 308(-) 841527978.695.494.976.92012 SLICC(+) 357(-) 352626891.193.291.288.42019 EULAR/ACR(+) 368(-) 242826693.892.990.591.7Conclusion:In this cohort, although all three criteria have sufficient specificity, sensitivity and negative predictive value of 1997 ACR criteria are the lowest. Overall, 2019 EULAR/ACR and 2012 SLICC criteria have a comparable performance, but if only ANA positive cases and controls are analysed, the specificity of both criteria decrease to less than 90%. Some SLE patients with a clinical diagnosis lacked sufficient number of criteria. Mostly, patients with Sjögren’s syndrome or antiphospholipid syndrome are prone to misclassification by both recent criteria.References:[1]Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis 2019;78:1151-1159.Disclosure of Interests:None declared

POS0747 MAPPING THE NATIONWIDE CLINICAL PROFILE AND PATTERNS OF CARE OF SLE IN BRAZIL – FINDINGS FROM THE MACUNAÍMA STUDY

Background:Systemic lupus erythematosus (SLE) is an autoimmune disease with wide clinical variability. Brazil has vast regional diversity, both from an ethnic and socio-cultural point of view.Objectives:To map the clinical profile of SLE in Brazil and explore how this distribution is associated with regional disparities.Methods:This cross-sectional study (GSK Study 207353) evaluated 300 Brazilian patients ≥18 years old with SLE (American College of Rheumatology [ACR] criteria, 1997) who had been under SLE care for ≥1 year. Five SLE reference teaching facilities were selected, one in each of the following Brazilian regions: North (NO), Northeast (NE), Midwest (CO), Southeast (SE), and South (SU). Each region included 60 patients. Clinical and demographic characteristics, and patterns of care were measured through questionnaires completed by physicians or nurses. The SLE Disease Activity Index (SLEDAI) score described disease activity and the Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) described damage accrual. To assess the potential association between regional disparities and clinical outcomes, a hospitalisation profile was described. A bootstrapping approach of logistic regression was used to explore potential factors associated with hospitalisation.Results:Overall, 92.3% of patients were female, with a mean (standard deviation; SD) age of 41.8 (12.7) years and a mean (SD) disease duration of 11.8 (7.9) years. Overall, 161 (53.7%) patients were of Latino origin; in the NO this proportion was 88%. White patients predominated in the SU (58.3%); and black patients in the SE (31.7%). The mean (SD) number of years of schooling was 11.3 (4.6), and was highest in the NO (14.2 [3.6]) and lowest in the SU (9.0 [4.0]; p<0.001). With regard to the distribution of the SLE clinical profile according to ACR criteria, arthritis was found in 221 patients and predominated in all regions (mean 73.7%), with a lower prevalence in the CO (40%; p<0.001; Figure 1A). The mean (SD) SLEDAI score was 4.33 (5.39) at the time of interview. The main contributing factors to disease activity, according to SLEDAI, were complement consumption (18%), arthritis (15.3%), and alopecia (15%). The SDI scale was scored for cataracts (15%), proteinuria (8.7%), and thrombosis (7.3%). Among the associated comorbidities, hypertension was predominant in the NO (35%; p=0.001). Smoking predominated in the SU (23%; p<0.001); obesity (27%; p=0.059) and dyslipidemia (35%; p=0.023), in the SE. Regarding patterns of care (Figure 1B), antimalarials were most frequently prescribed in the SE (88.3%) and the SU (91.7%). Corticosteroids prevailed in the NO (96.7%). The mean (SD) time between home and care facility was 4.5 (12.6) hours. Patients in the NO reported the longest transport time to reach the care facility (11.5 [25.4] hours; p<0.001). The hospitalisation rate during the study period was 21.3% across all regions, with no statistical difference between centres (p=0.651). Reasons for hospitalisation included disease activity (36 [12%]), infection (19 [6.3%]), surgery (10 [3.3%]), and management of clinical morbidities (6 [2.0%]). Hospitalisation was associated with ethnicity (p<0.016), occupational status (p<0.001), age (p=0.02), and the use of hydroxychloroquine (HCQ) or chloroquine (CQ; p<0.001).Conclusion:This nationwide study highlights ethnic, social, and patterns-of-care disparities among Brazilian patients with SLE. The modelling shows evidence that such disparities contribute to the divergent clinical spectrum observed in Brazil.Funding:GSKFigure 1.Distribution of the A) Brazilian SLE clinical profile according to the ACR Classification Criteria and B) Brazilian prescriptive profile for SLE treatment according to the use of immunosuppressive drugs, biological agents, and corticosteroids during the study (12 months)ANA, antinuclear antibodyAcknowledgements:Medical writing assistance was provided by Helen Taylor, Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GSK.Disclosure of Interests:Mirhelen Abreu Grant/research support from: GSK, Amgen, Biogen, Libbs, Odirlei Monticielo Speakers bureau: GSK, AbbVie, UCB, Roche, Novartis, Consultant of: GSK, AbbVie, Janssen, Vander Fernandes Speakers bureau: Janssen, Novartis, Roche, AbbVie, Pfizer, Grant/research support from: Novartis, GSK, Pfizer, Alexandre Cristovão Maiorano: None declared, Fernando dos Santos Beserra: None declared, Flavia Lamarao Employee of: GSK, Nathalie David Shareholder of: GSK, Employee of: GSK, Bruna de Veras Employee of: GSK, Blanca Bica: None declared, Domingos Sávio Nunes de Lima Grant/research support from: GSK, Marta Maria das Chagas Medeiros: None declared

POS0771 VALIDATION OF THE 2019 EUROPEAN LEAGUE AGAINST RHEUMATISM/AMERICAN COLLEGE OF RHEUMATOLOGY (EULAR/ACR) CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) IN HONG KONG CHINESE

Objectives:To validate the 2019 EULAR/ACR classification criteria for SLE in Hong Kong Chinese patients and compare its performance with the 2012 Systemic Lupus International Collaborating Clinics (SLICC) and 1997 American college of rheumatology (ACR) criteria.Methods:We retrospectively reviewed the medical records of consecutive patients who attended the Rheumatology clinics in Tuen Mun and Pok Oi hospitals between May and September 2019. Patients with anti-nuclear antibody (ANA) ≥1:80 were included and patients with ANA <1:80 or no ANA results were excluded. Patients were evaluated and cross-checked for the fulfilment of the 1997 ACR, 2012 SLICC and 2019 EULAR/ACR criteria by two investigators (YKC,CL). Medical records were then reviewed by an expert panel consisting of 3 senior rheumatologists, who were blinded for the results of the criteria evaluation, for a diagnosis of SLE based on the clinical judgement and therapeutic decisions. Teleconferences were arranged by the panel to discuss the discrepancies of the final diagnosis and agreement was made by voting. The three SLE criteria were evaluated against the clinical diagnosis of SLE as judged by the expert panel on the sensitivity and specificity, which was calculated by 2x2 contingency tables (“condition positive” = clinical diagnosis of SLE; “test positive” = criteria positive for SLE) with standard formulas (sensitivity = true positive/[true positive + false negative]; specificity = true negative / [true negative + false positive]). Receiver operating characteristic (ROC) curve was used to study the optimal cut-off points from the EULAR/ACR criteria for the highest summation of specificity and sensitivity.Results:3967 patients were screened; 1542 patients who were positive for ANA (≥1:80) were included (88.3% women). The mean age of these patients at first rheumatology clinic attendance was 45.6±15.0 years and the duration of follow-up was 7.5±7.0 years. A total of 567 patients were judged to have SLE by the expert panel (discrepancy of clinical diagnosis in 135 patients resolved with voting). The sensitivity and specificity of the three SLE classification criteria in our patients are listed in Table 1. ROC analysis showed that the best cut-off for a clinical diagnosis of SLE using the EULAR/ACR criteria was 10 points (area under the curve [AUC] 0.977; sensitivity 89.2% and specificity 89.6%). Similar figures were obtained for subgroups of patients stratified by gender and different age ranges.Conclusion:In our cohort of Hong Kong Chinese patients, the 2019 EULAR/ACR criteria is more sensitive but less specific when compared with 1997 ACR criteria for classifying SLE. On the other hand, the EULAR/ACR criteria is less sensitive but more specific than the 2012 SLICC criteria. The specificity of the EULAR/ACR criteria for SLE is higher in male than female patients. In our patients older than 50 years, the EULAR/ACR criteria is less sensitive but more specific for a classification of SLE. Overall, the performance of the EULAR/ACR criteria for a diagnosis of SLE in our study is similar to that reported in recent Asian studies although the sensitivity is lower, which may be related to the inclusion of ANA+ patients only.References:Classification criteriaSensitivitySpecificity1997 ACR85.9%94.4%2012 SLICC97.5%86.4%2019 EULAR/ACR with 10 points as cut-off89.2%89.6%2019 EULAR/ACR with 9 points as cut-off93.6%68.7%2019 EULAR/ACR with 11 points as cut-off86.9%92.4%2019 EULAR/ACR with 10 points as cut-off (men)88.9%94.5%2019 EULAR/ACR with 10 points as cut-off (women)89.2%88.8%2019 EULAR/ACR with 10 points as cut-off (age >50 years)78.7%94.1%2019 EULAR/ACR with 10 points as cut-off (age ≤50 years)91.7%84.1%Disclosure of Interests:None declared

P123 Evaluating the performance of ACR, SLICC and EULAR/ACR classification criteria in childhood onset systemic lupus erythematosus

Background/Aims The aim of the study is to compare the performance characteristics among three SLE classification criteria (ACR-1997, SLICC-2012 and EULAR/ACR-2019) in childhood onset SLE (cSLE) cohort of Arab ethnicity from Oman. Methods We conducted a retrospective multicenter study among pediatric rheumatology centers in Oman. Cases were cSLE and controls were patients with other rheumatic disease with a positive ANA titer followed up over the past 10 years. Data were retrospectively collected to establish the ACR, SLICC and EULAR/ACR criteria fulfilled at first visit, first year follow up and last year of follow up. Results Study population included 113 cSLE cases (mean age at diagnosis 7.3 ± 3.4 years with disease duration 6.13± 4.6 years and 38% family history of SLE) and 51 controls (mean age at diagnosis 5.0 ± 3.4 years with disease duration 5.7 ± 3.9 years and 4% family history of SLE). Table 1 demonstrates the result of the performance measures for the ACR, SLICC and EULAR/ACR criteria at first visit, first year and last follow up. P123 Table 1:Performance measures for the ACR 1997, SLICC 2012 and ACR/EULAR 2019 classification criteria according to first visit, first year and latest periods.CriteriaSensitivity (95% CI)Specificity (95% CI)PPV (95% CI)NPV (95% CI)ROC (95% CI)Accuracy (95% CI)ACR 19971st visit49% (40%-59%)96% (87%-99%)97% (88%-99%)46% (36%-56%)0.73 (0.67-0.78)64% (56%-71%)1st year57% (47-66%)96% (87%-99%)97% (90%-99%)50% (40%-60%)0.76 (0.71-0.82)69% (61%-76%)Latest66% (56%-74%)96% (87%-99%)97% (91%-99%)56% (45%-66%)0.81 (0.76-0.86)75% (68%-81%)SLICC1st visit76% (67%-84%)94% (84%-99%)97% (91%-99%)64% (52%-75%)0.85 (0.80-0.90)82% (75%-87%)1st year84% (76%-90%)94% (84%-99%)97% (91%-99%)73% (60%-83%)0.89 (0.84-0.94)87% (81%-92%)Latest86% (78%-92%)94% (84%-99%)97% (92%-99%)75% (63%-85%)0.90 (0.85-0.95)88% (83%-93%)ACR/EULAR1st visit81% (73%-88%)92% (81%-98%)96% (90%-99%)69% (57%-80%)0.87 (0.82-0.92)85% (78%-90%)1st year88% (80%-93%)90% (79%-97%)95% (89%-98%)77% (64%-87%)0.89 (0.84-0.94)88% (83%-93%)Latest89% (82%-94%)90% (79%-97%)95% (89%-99%)79% (67%-89%)0.90 (0.85-0.95)90% (84%-94%)ACR/EULAR*1st visit76% (67%-84%)96% (87%-99%)98% (92%-99%)65% (53%-75%)0.86 (0.81-0.91)83% (76%-88%)1st year83% (74%-89%)96% (87%-99%)98% (93%-99%)71% (59%-81%)0.89 (0.85-0.94)87% (81%-92%)Latest84% (76%-90%)96% (87%-99%)98% (93%-99%)73% (61%-83%)0.90 (0.86-0.94)88% (83%-93%)ACR, American College of Rheumatology 1997; SLICC, Systemic Lupus Erythematosus International Collaborating Clinics; EULAR, European League Against Rheumatism; CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value; ROC, area under the received operating curve. ACR/EULAR*, a score of ≥ 13 as compared to the traditional cut of score of ≥ 10. The median disease duration was 5 (2.5-9) years with a range of 1-19 years. Conclusion In this cSLE population, the EULAR/ACR criteria scored better in sensitivity at first, one year and last follow up; while the ACR 1997 scored better in specificity at first, one year and last follow up. However, if the EULAR/ACR cut score ≥ 13 (rather than traditional cut-score ≥ 10) then it an equivalent specificity to ACR 1997 at the expense of lower sensitivity. Disclosure R. Abdwani: None. E. Al Masroori: None. E. Abdalla: None. S. Al Abrawi: None. I. Al Zakwani: None.

Proportion of Osteoarthritis Knee among Older Adults Presenting with Knee Complaints as Assessed Using American College of Rheumatology (ACR) Criteria at A Tertiary Care Hospital, Kollam

Introduction: Osteoarthritis is one of the most prevalent musculoskeletal disorders seen as age increases. Among older individuals it leads to persistent complaints, disability and health care consultations. Objective: To estimate the proportion of osteoarthritis knee using American College Of Rheumatology (ACR) criteria among older individuals presenting with history of persistent knee complaints in a tertiary care setting. Method: A hospital based cross-sectional study was conducted to assess the proportion of osteoarthritis knee among older patients presenting with persistent knee complaints in orthopedic OP of Government Medical College Kollam. A semi-structured questionnaire was used to collect data regarding socio-demographic profile. Assessment of osteoarthritis knee was done Using American College Of Rheumatology (ACR) Criteria. Results: The proportion of osteoarthritis in any knee among older adults was found to be 72%, with bilateral osteoarthritis knee seen in 38.5%. Among those affected, 84% were women. Knee pain, presence of crepitus and bony tenderness were the most common findings among those with OA knee. Conclusion: The proportion of OA knee was found to be higher among the study population. Older age group and females were more prone to osteoarthritis of knee. An estimate of the burden of OA in older patients will help policy makers in planning public health programs to improve their health condition and quality of life.

Hip osteoarthritis signs and symptoms are associated with increased fall risk among community-dwelling older adults with chronic low back pain: a prospective study

Background Older adults with concurrent low back and hip pain are predisposed to reductions in physical performance and health-related quality of life. Yet no study to date has assessed whether or not coexisting hip impairments increase fall risk in older adults with chronic low back pain (CLBP). The objective of this study was to determine if hip osteoarthritis (OA) signs and symptoms per American College of Rheumatology (ACR) criteria are associated with fall risk over a 1-year span. Methods Falls were prospectively monitored for 1 year via fall calendars. Age, sex, body mass index (BMI), anxiolytic use, balance confidence, LBP-related disability, and prior fall history were identified as covariates. Hip pain, pain with hip internal rotation (IR), hip IR range of motion (ROM) ≥ 15°, and morning stiffness lasting ≤ 60 min were evaluated at baseline and summed to represent hip OA impairment burden. A generalized linear model with a Poisson distribution and log link function assessed the association between ACR criteria and fall risk beyond established covariates. As a secondary analysis, binary logistic regression assessed ACR criteria and the odds of falling two or more times within a year. Results Data from two-hundred and ten participants were analyzed. Hip OA signs and symptoms were present in 97.1% of the participants, and hip OA impairment burden was significantly greater (p < 0.050) in participants who fell ≥ 2 times compared to single and non-fallers. Higher hip OA impairment burden was associated with significantly increased fall risk (p = 0.001, risk ratio = 1.23, 95% CI 1.09–1.38) and odds of falling multiple times (p < 0.05, odds ratio = 1.41, 95% CI 1.01–1.95) after adjustment for covariates. Conclusions Older adults with CLBP and concomitant hip impairments are an at-risk group for falling. Healthcare professionals should employ falls screening and preventive measures to avoid negative sequelae in this vulnerable population.

Performance of the 2019 EULAR/ACR systemic lupus erythematosus classification criteria in a cohort of patients with biopsy-confirmed lupus nephritis

ObjectiveTo evaluate the performance of the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) SLE classification criteria in a cohort of patients with biopsy-confirmed lupus nephritis (LN) and their renal prognosis.MethodsPatients with newly diagnosed SLE attending and followed up for >12 months were included. A retrospective review of all patients with renal biopsy fulfilling a consensus expert opinion during 2014 and 2018. Clinical, serological and pathological data were collected and each patient was assigned a high/low criteria scores (HS/LS) group. Survival curves for flare adjusted for multiplicity on renal flares, was applied to the two groups.ResultsApplying EULAR/ACR criteria in our cohort of 126 patients, 6 (4.76%) did not meet the criterion, resulting in a sensitivity of 95.24%. The EULAR/ACR criteria scores was positively correlated with SLE disease activity index scores. Additionally, we noticed that a significant difference in clinical and immunological manifestations between HS and LS group. We observed a higher proportions of class Ⅲ or Ⅳ LN and lower proportions of class Ⅱ or V LN (p=0.034) and pathological higher activity index in HS group (p=0.007). Compared with LS groups, patients involved more severe renal damage and achieved higher rate of complete remission in the HS group. The Kaplan-Meier exploratory analyses, adjusted for LN classification, estimated glomerular filtration rate, activity index and chronicity index and induction and maintenance treatments, showed that patients in the HS group had a tendency of higher renal flare risk than that in the LS group (HR=0.21, p=0.04).ConclusionsThe EULAR/ACR criteria performed high sensitivity in identifying SLE in this cohort of biopsy-confirmed LN. Patients with LN with high criteria scores had more extrarenal manifestations, and worse renal prognosis in the short and long terms.