Kozhikode criteria for diagnosing systemic lupus erythematosus as a hematological disorder

Figures & data

Figure 1 Distribution of cases based on whether or not they satisfied the criteria.

Abbreviation: ACR, American College of Rheumatology.

Table 1 Average time required to satisfy the ACR criteria among the cases

Serial number	Diagnosis	Average time from diagnosis to satisfying ACR criteria (months)
1	ITP	32
2	ITP	72
3	ITP, hypothyroidism	40
4	AIHA	7
5	AIHA, nephrotic syndrome	64
6	Polyarthralgia	4
7	APLA, high ESR	14
8	CVA, ITP, high ESR	144
9	Anemia, splenomegaly	6
10	Secondary Sjögren’s syndrome	4
11	Thyrotoxicosis	11
12	Polyarthralgia	8
13	Polyarthralgia	4
14	Anemia, high ESR	12
15	Pancytopenia	12
16	MDS	60

Abbreviations: ACR, American College of Rheumatology; ITP, immune thrombocytopenic purpura; AIHA, autoimmune hemolytic anemia; APLA, antiphospholipid antibody syndrome; ESR, erythrocyte sedimentation rate; CVA, cerebrovascular accident; MDS, myelodysplastic syndrome.

Figure 2 Clinical manifestations in patients with SLE.

Abbreviations: SLE, systemic lupus erythematosus; PUO, pyrexia of unknown origin.

Figure 3 Level of physical activity in the patients with SLE.

Abbreviation: SLE, systemic lupus erythematosus.

Table 2 Comparison of ACR criteria and Kozhikode criteria

ACR criteria	Kozhikode criteria
Classification criteria only. Cannot be used for diagnosing SLE.	Diagnostic criteria.
Requires at least four of the eleven criteria, most of which are not present at the time of initial presentation and could be present at any time in a patient’s history – delays diagnosis.	Requires four of the six and are easily available features occurring early on, as the diagnosis of SLE is based on clinical suspicion. Useful criterion promotes early diagnosis.
Underrepresentation of hematological manifestations, which is more common in at least our subset of patients.	Adequate representation of hematological manifestations.
Presence of antinuclear antibodies is given equal weightage as other criteria.	Antinuclear antibody is only a minor criterion and helps in identification of ANA-negative SLE.

Abbreviations: ANA, antinuclear antibody; ACR, American College of Rheumatology; SLE, systemic lupus erythematosus.