Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 721-726 |
| Number of pages | 6 |
| Journal | Journal of Rheumatology |
| Volume | 46 |
| Issue number | 7 |
| DOIs | |
| State | Published - 2019 |
Funding
From the Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto; University Health Network, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan; University of California, Los Angeles, Los Angeles; University of California, San Francisco, California; Brigham and Women’s Hospital, Boston; Harvard Medical School, Boston, Massachusetts; Medical University of South Carolina, Charleston, South Carolina; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Hospital Clínic, Barcelona, Spain; AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d’île de France, Paris; Université Paris Descartes-Sorbonne Paris Cité, Paris; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France; Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin; Berlin Institute of Health, Department of Rheumatology and Clinical Immunology, Berlin; University Medical Center and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; National and Kapodestrian University of Athens, and Biomedical Research Foundation of the Athens Academy, Athens, Greece; Department of Medicine, University of Cambridge, Cambridge, UK; University of Pisa, Pisa, Italy; Medical University of Vienna, Vienna, Austria. This study was jointly supported by the European League Against Rheumatism and the American College of Rheumatology. Dr. Johnson is supported by a Canadian Institutes of Health Research New Investigator Award. Dr. Khanna was supported by a grant from the US National Institutes of Health/ National Institute of Arthritis and Musculoskeletal and Skin Diseases K24 AR 063120. S.R. Johnson, MD, PhD, FRCPC, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto; D. Khanna, MD, MS, Division of Rheumatology, Department of Medicine, University of Michigan; R. Cervera, MD, PhD, FRCP, Hospital
Keywords
- CLASSIFICATION CRITERIA
- CONSENSUS METHODS
- NOMINAL GROUP TECHNIQUE
- SYSTEMIC LUPUS ERYTHEMATOSUS
ASJC Scopus subject areas
- Rheumatology
- Immunology and Allergy
- Immunology