The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes

Matthew H. Liang, Michael Corzillius, Sang Cheol Bae, Robert A. Lew, Paul R. Fortin, Caroline Gordon, David Isenberg, Graciela S. Alarcón, Karin V. Straaton, Judah Denburg, Susan Denburg, John M. Esdaile, Bonnie I. Glanz, Elizabeth W. Karlson, Shahram Khoshbin, Malcolm P. Rogers, Peter H. Schur, John G. Hanly, Elizabeth Kozora, Sterling WestRobert G. Lahita, Michael D. Lockshin, Joseph McCune, Patricia M. Moore, Michelle Petri, W. Neal Roberts, Jorge Sanchez-Guerrero, Martin Veilleux, Robin Brey, Wayne D. Cornblath, Christopher M. Filley, John D. Fisk, Pontus Harten, Elaine M. Hay, Grant Iverson, Steven R. Levine, Elizabeth Waterhouse, Daniel J. Wallace, John B. Winer

Research output: Contribution to journalArticlepeer-review

1453 Scopus citations


Objective. To develop a standardized nomenclature system for the neuropsychiatric syndromes of systemic lupus erythematosus (NPSLE). Methods. An international, multidisciplinary committee representing rheumatology, neurology, psychiatry, neuropsychology, and hematology developed case definitions, reporting standards, and diagnostic testing recommendations. Before and after the meeting, clinician committee members assigned diagnoses to sets of vignettes randomly generated from a pool of 108 NPSLE patients. To assess whether the nomenclature system improved diagnostic agreement, a consensus index was developed and pre- and postmeeting scores were compared by t-tests. Results. Case definitions including diagnostic criteria, important exclusions, and methods of ascertainment were developed for 19 NPSLE syndromes. Recommendations for standard reporting requirements, minimum laboratory evaluation, and imaging techniques were formulated. A short neuropsychological test battery for the diagnosis of cognitive deficits was proposed. In the postmeeting exercise, a statistically significant improvement in diagnostic agreement was observed. Conclusion. The American College of Rheumatology (ACR) Nomenclature for NPSLE provides case definitions for 19 neuropsychiatric syndromes seen in SLE, with reporting standards and recommendations for laboratory and imaging tests. It is intended to facilitate and enhance clinical research, particularly multicenter studies, and reporting. In clinical settings, consultation with other specialists may be required. It should be useful for didactic purposes but should not be used uncritically or as a substitute for a clinical diagnosis. The complete case definitions are available on the ACR World Wide Web site:

Original languageEnglish (US)
Pages (from-to)599-608
Number of pages10
JournalArthritis and rheumatism
Issue number4
StatePublished - Apr 1999

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Pharmacology (medical)


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