ACR Diagnostic Criteria for SLE

A person is defined as having SLE if any 4 or more of the 11 criteria are present, serially or simultaneously, during any interval of observation.

1. Malar Rash: Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds

2. Discoid rash: Erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions

3. Photosensitivity: Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation

4. Oral ulcers: Oral or nasopharyngeal ulceration, usually painless, observed by physician

5. Non-erosive arthritis: Involving 2 or more peripheral joints, characterized by tenderness, swelling, or effusion

6. Pleuritis or pericarditis

  • Pleuritis: convincing history of pleuritic pain or rubbing heard by a physician or evidence of pleural effusion
  • Pericarditis: documented by electrocardiogram or rub or evidence of pericardial effusion

7. Renal disorder

  • Persistent proteinuria > 0.5 grams per day or > than 3+ if quantitation not performed
  • Cellular casts: may be red cell, hemoglobin, granular, tubular, or mixed

8. Neurologic disorder

  • Seizures: in the absence of offending drugs or known metabolic derangements; e.g., uremia, ketoacidosis, or electrolyte imbalance
  • Psychosis: in the absence of offending drugs or known metabolic derangements, e.g., uremia, ketoacidosis, or electrolyte imbalance

9. Hematologic disorder

  • Hemolytic anemia–with reticulocytosis OR
  • Leukopenia–< 4,000/mm3 on ≥ 2 occasions OR
  • Lymphopenia–< 1,500/ mm3 on ≥ 2 occasions OR
  • Thrombocytopenia–<100,000/ mm3 in the absence of offending drugs

10. Immunologic disorder

  • Anti-DNA: antibody to native DNA in abnormal titer OR
  • Anti-Sm: presence of antibody to Sm nuclear antigen OR
  • Positive finding of antiphospholipid antibodies on:
    • abnormal serum IgG or IgM anticardiolipin antibodies OR
    • positive lupus anticoagulant using a standard method OR
    • false-positive test result for at least 6 months confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test

11. Positive antinuclear antibody: An abnormal titer of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs

See the full guidelines here.