European League Against Rheumatism and are jointly supporting multiphase development of systemic lupus erythematosus (SLE) classification criteria based on weighted criteria and a continuous probability scale. Prior steps included item generation, item reduction and hierarchical organisation of candidate criteria using an evidence-based approach. Our objectives were to determine relative weights using multicriteria decision analysis (MCDA) and to set a provisional threshold score for SLE classification. An SLE Expert Panel (8 European, 9 North American) submitted 164 real, unique cases with a wide range of SLE probability in a standardised format. Using the candidate criteria, experts scored and rank-ordered 20 representative cases. At an in-person meeting, experts reviewed inter-rater reliability of scoring, further refined criteria definitions and participated in an MCDA exercise. Based on expert consensus decisions on pairwise comparisons of criteria, 1000minds software calculated criteria weights and rank-ordered the remaining 144 cases based on their additive scores. The score of the lowest-ranked case for which complete expert consensus was achieved defined the provisional threshold classification score. Inter-rater reliability of scoring cases with the candidate criteria was good. MCDA involved 74 pairwise decisions and was repeated for the arthritis and mucocutaneous domains when the initial ranking of some cases did not match expert opinion. After criteria weights and additive scores were recalculated once, experts reached consensus for SLE classification for all cases scoring>83. Using an iterative process, the candidate criteria definitions were refined, preliminary weights were calculated and a provisional threshold score for SLE classification was determined.
- systemic lupus erythematosus
- clinical research
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Handling editor David S Pisetsky
Contributors SRJ, DJ, JSS, RPN, MA and KHC were responsible for planning this work. SKT, SRJ, DTB, DD,TD, BD, SJ, DLK, WJM, MM, RR-G, GR-I, MS, MU, DW, JSS, RPN, MA and KHC conducted this work. SKT, SRJ, DTB, DD,TD, BD, SJ, DLK, WJM, MM, RR-G, GR-I, MS, MU, DW, JSS, RPN, MA and KHC contributed to manuscript preparation.
Funding This work was jointly supported by the European League Against Rheumatism and the American College of Rheumatology. SKT’s work on this project was supported in part by the Lupus Foundation of America Career Development Award and NIAMS L30 AR070514. SRJ was supported by a Canadian Institutes of Health Research New Investigator Award. SJ was supported by a grant from the Danish Rheumatism Association (A-3865).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.