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Multicriteria decision analysis process to develop new classification criteria for systemic lupus erythematosus
  1. Sara K Tedeschi1,
  2. Sindhu R Johnson2,
  3. Dimitrios T Boumpas3,
  4. David Daikh4,5,
  5. Thomas Dörner6,
  6. Betty Diamond7,
  7. Søren Jacobsen8,
  8. David Jayne9,
  9. Diane L Kamen10,
  10. W Joseph McCune11,
  11. Marta Mosca12,
  12. Rosalind Ramsey-Goldman13,
  13. Guillermo Ruiz-Irastorza14,
  14. Matthias Schneider15,
  15. Murray Urowitz2,
  16. David Wofsy4,
  17. Josef S Smolen16,
  18. Raymond P Naden17,
  19. Martin Aringer18,
  20. Karen H Costenbader1
  1. 1 Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  3. 3 Departments of Internal Medicine and Rheumatology, Clinical Immunology and Allergy, University of Crete, Heraklion, Greece
  4. 4 Department of Medicine, University of California San Francisco, San Francisco, California, USA
  5. 5 Department of Medicine, VA Medical Center, San Francisco, California, USA
  6. 6 Department of Medicine/Rheumatology and Clinical Immunology, Charite University Hospitals, Berlin, Germany
  7. 7 Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Feinstein Institute for Medical Research, Manhasset, New York, USA
  8. 8 Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  9. 9 Department of Medicine, University of Cambridge, Cambridge, UK
  10. 10 Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  11. 11 Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
  12. 12 Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
  13. 13 Department of Medicine/Division of Rheumatology, Northwestern University, Chicago, Illinois, USA
  14. 14 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, Spain
  15. 15 Rheumatology Department, University Hospital Dusseldorf, Dusseldorf, Germany
  16. 16 Department of Rheumatology, Medical University of Vienna, Vienna, Austria
  17. 17 Department of Medicine, McMaster University, Hamilton, Canada
  18. 18 Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany
  1. Correspondence to Dr Sara K Tedeschi, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA; stedeschi1{at}


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
  • methodology

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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.