Classification of systemic lupus erythematosus — ANA entry criterion plus weighted criteria (threshold ≥ 10)
Tick a criterion only if SLE is its most likely explanation. It only needs to have occurred once, and criteria need not be simultaneous. Within each domain only the highest-weighted criterion counts.
Entry criterion (required)
ANA ≥ 1:80 on HEp-2 cells (or an equivalent positive test), at least once
Constitutional
Fever > 38.3 °C (2)
Haematologic
Leukopenia, WBC < 4,000/mm³ (3)
Thrombocytopenia, platelets < 100,000/mm³ (4)
Autoimmune haemolysis — evidence of haemolysis and a positive direct Coombs test (4)
Neuropsychiatric
Delirium (2)
Psychosis — delusions/hallucinations without insight, no delirium (3)
Seizure, generalised or focal (5)
Mucocutaneous
Non-scarring alopecia, observed by a clinician (2)
Oral ulcers, observed by a clinician (2)
Subacute cutaneous or discoid lupus (4)
Acute cutaneous lupus — malar or generalised maculopapular rash (6)
Joint involvement — synovitis in ≥ 2 joints, or tenderness in ≥ 2 joints with ≥ 30 min morning stiffness (6)
Renal
Proteinuria > 0.5 g/24 h, or equivalent spot protein:creatinine ratio (4)
Renal biopsy: class II or V lupus nephritis (8)
Renal biopsy: class III or IV lupus nephritis (10)
Anti-phospholipid antibodies
Anti-cardiolipin (medium/high titre) or anti-β2GP1 antibodies, or lupus anticoagulant (2)
Complement proteins
Low C3 or low C4 (3)
Low C3 and low C4 (4)
SLE-specific antibodies
Anti-dsDNA (assay ≥ 90% specific) or anti-Smith antibody (6)
Evidence
Original publication
Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Introduced the ANA entry criterion, the ten weighted domains, and the threshold of ≥ 10 points with at least one clinical criterion used here; sensitivity 96.1% and specificity 93.4% in the validation cohort (696 SLE, 574 controls). Published simultaneously in Arthritis & Rheumatology 2019;71(9):1400–1412 and Annals of the Rheumatic Diseases 2019;78(9):1151–1159.
Arthritis & Rheumatology, 2019
Open source
Guideline
These are classification criteria, developed to define homogeneous groups for research; they are not diagnostic criteria and must not be used to withhold treatment from a patient who does not fully meet them (including persistently ANA-negative disease). A criterion is counted only if SLE is the most likely explanation for it, so infection, drugs, and other causes must be considered first — fever in particular. Criteria may have occurred at any time and need not be simultaneous. The cohorts included few children and few patients with skin-predominant disease, so performance in those groups is less well established. The 2012 SLICC criteria are available separately in this app.
Last reviewed: 2026-09
Report an error in this calculator
MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.