Table 1.

American College of Rheumatology (ACR) revised classification criteria for systemic lupus erythematosus.

Criteria	Definition
Malar rash	Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds
Discoid rash	Erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring occurs in older lesions
Photosensitivity	Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation
Oral ulcers	Oral or nasopharyngeal ulceration, usually painless, observed by a physician
Arthritis	Nonerosive arthritis involving two or more peripheral joints, characterized by tenderness, swelling, or effusion
Serositis	(a) Pleuritis—convincing history of pleuritic pain or rub heard by a physician or evidence of pleural effusion (b) Pericarditis—documented by ECG or rub or evidence of pericardial effusion
Renal disorder	(a) Persistent proteinuria > 0.5 g/day > 3+ if quantitation is not performed (b) Cellular casts—may be red blood cell, hemoglobin, granular tubular, mixed
Neurologic disorder	(a) Seizures—in the absence of offending drugs or known metabolic derangements (e.g., uremia, acidosis, or  electrolyte imbalance) (b) Psychosis—in the absence of offending drugs or known metabolic derangements (e.g., uremia, acidosis,  or electrolyte imbalance)
Hematologic disorder	(a) Hemolytic anemia with reticulocytosis (b) Leukopenia—<4000/mm (c) Lymphopenia—<1500/mm (d) Thrombocytopenia—<100,000/mm in the absence of offending drugs
Immunologic disorder	(a) Anti-DNA—antibody to native DNA in abnormal titer (b) Anti-Sm—presence of antibody to Sm nuclear antigen (c) Positive finding of antiphospholipid antibodies based on (1) abnormal serum concentration of IgG or  IgM anticardiolipin antibodies, (2) positive test result for lupus anticoagulant using a standard method,  or (3) false-positive serologic test for syphilis known to be positive for at least 6 mo and confirmed by  Treponema pallidum immobilization or fluorescent treponemal antibody absorption test
ANA	Abnormal titer of ANA by immunofluorescence or equivalent assay at any point in time and in the absence of drugs known to be associated with drug-induced lupus syndrome