TY - JOUR
T1 - Use of consensus methodology to determine candidate items for systemic lupus erythematosus classification criteria
AU - Johnson, Sindhu R.
AU - Khanna, Dinesh
AU - Daikh, David
AU - Cervera, Ricard
AU - Costedoat-Chalumeau, Nathalie
AU - Gladman, Dafna D.
AU - Hahn, Bevra H.
AU - Hiepe, Falk
AU - Sánchez-Guerrero, Jorge
AU - Massarotti, Elena
AU - Boumpas, Dimitrios T.
AU - Costenbader, Karen H.
AU - Jayne, David
AU - Dörner, Thomas
AU - Kamen, Diane L.
AU - Mosca, Marta
AU - Ramsey-Goldman, Rosalind
AU - Smolen, Josef S.
AU - Wofsy, David
AU - Aringer, Martin
N1 - Publisher Copyright:
Copyright © 2019. All rights reserved.
PY - 2019
Y1 - 2019
N2 - Objective. Given the complexity and heterogeneity of systemic lupus erythematosus (SLE), high-performing classification criteria are critical to advancing research and clinical care. A collaborative effort by the European League Against Rheumatism and the American College of Rheumatology was undertaken to generate candidate criteria, and then to reduce them to a smaller set. The objective of the current study was to select a set of criteria that maximizes the likelihood of accurate classification of SLE, particularly early disease. Methods. An independent panel of international SLE experts and the SLE classification criteria steering committee (conducting SLE research in Canada, Mexico, United States, Austria, Germany, Greece, France, Italy, and Spain) ranked 43 candidate criteria. A consensus meeting using nominal group technique (NGT) was conducted to reduce the list of criteria for consideration. Results. The expert panel NGT exercise reduced the candidate criteria for SLE classification from 43 to 21. The panel distinguished potential "entry criteria," which would be required for classification, from potential "additive criteria." Potential entry criteria were antinuclear antibody (ANA) = 1:80 (HEp-2 immunofluorescence), and low C3 and/or low C4. The use of low complement as an entry criterion was considered potentially useful in cases with negative ANA. Potential additive criteria included lupus nephritis by renal biopsy, autoantibodies, cytopenias, acute and chronic cutaneous lupus, alopecia, arthritis, serositis, oral mucosal lesions, central nervous system manifestations, and fever. Conclusion. The NGT exercise resulted in 21 candidate SLE classification criteria. The next phases of SLE classification criteria development will require refinement of criteria definitions, evaluation of the ability to cluster criteria into domains, and evaluation of weighting of criteria.
AB - Objective. Given the complexity and heterogeneity of systemic lupus erythematosus (SLE), high-performing classification criteria are critical to advancing research and clinical care. A collaborative effort by the European League Against Rheumatism and the American College of Rheumatology was undertaken to generate candidate criteria, and then to reduce them to a smaller set. The objective of the current study was to select a set of criteria that maximizes the likelihood of accurate classification of SLE, particularly early disease. Methods. An independent panel of international SLE experts and the SLE classification criteria steering committee (conducting SLE research in Canada, Mexico, United States, Austria, Germany, Greece, France, Italy, and Spain) ranked 43 candidate criteria. A consensus meeting using nominal group technique (NGT) was conducted to reduce the list of criteria for consideration. Results. The expert panel NGT exercise reduced the candidate criteria for SLE classification from 43 to 21. The panel distinguished potential "entry criteria," which would be required for classification, from potential "additive criteria." Potential entry criteria were antinuclear antibody (ANA) = 1:80 (HEp-2 immunofluorescence), and low C3 and/or low C4. The use of low complement as an entry criterion was considered potentially useful in cases with negative ANA. Potential additive criteria included lupus nephritis by renal biopsy, autoantibodies, cytopenias, acute and chronic cutaneous lupus, alopecia, arthritis, serositis, oral mucosal lesions, central nervous system manifestations, and fever. Conclusion. The NGT exercise resulted in 21 candidate SLE classification criteria. The next phases of SLE classification criteria development will require refinement of criteria definitions, evaluation of the ability to cluster criteria into domains, and evaluation of weighting of criteria.
KW - CLASSIFICATION CRITERIA
KW - CONSENSUS METHODS
KW - NOMINAL GROUP TECHNIQUE
KW - SYSTEMIC LUPUS ERYTHEMATOSUS
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U2 - 10.3899/jrheum.180478
DO - 10.3899/jrheum.180478
M3 - Article
C2 - 30554156
AN - SCOPUS:85068570771
SN - 0315-162X
VL - 46
SP - 721
EP - 726
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 7
ER -