Multicenter Delphi Exercise to Identify Important Key Items for Classifying Systemic Lupus Erythematosus
Open accessAbstract
Objective: The American College of Rheumatology and the European League Against Rheumatism embarked on a project to reevaluate classification criteria for systemic lupus erythematosus ( SLE ). The first phase of the classification project involved generation of a broad set of items potentially useful for classification of SLE and their selection for use in a subsequent forced‐choice decision analysis. Methods: A large international group of expert lupus clinicians was invited to participate in a 2‐step process to generate, rate, and select items based on their importance in diagnosing early and established SLE , via a web‐based survey. Results: A total of 135 and 147 experts were invited to participate in the item‐generation and item‐reduction process, respectively. Of 145 items generated, item reduction resulted in 40 candidate items moving forward to the next phase. Key features for classifying both early and established SLE included characteristic autoantibodies, specific renal features, and skin manifestations. A small majority (51%) stated that 1 organ system would be sufficient for classifying SLE , but that additional typical laboratory features (antinuclear antibody, anti–double‐stranded DNA ) would be required. Notably, 85% of the expert group would positively classify SLE if renal pathology alone showed lupus nephritis. Conclusion: The Delphi exercise resulted in a set of 40 candidate criteria for the classification of SLE for subsequent assessment. This study comprised the largest panel ever involved in the development of SLE classification criteria, providing a broadly representative view of the current approach to classification of SLE .
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Little information is given on the basis for inclusion of the anti-dsDNA test in the criteria, suggesting that this item is largely based on expert opinion.
“Little information is given on the basis for inclusion of the anti-dsDNA test in the criteria, suggesting that this item is largely based on expert opinion [24,25].”
From Anti-dsDNA antibodies in the classification criteria of systemic lupus erythematosus (2022) · cites this paper as [25]
The Results (Thematic analysis; page unavailable) report that 99% of experts considered anti-dsDNA and anti-Sm the most typical serologic findings of SLE, supporting an expert-opinion basis for considering anti-dsDNA. But the Methods (Item generation; page unavailable) also describe a literature review and inclusion of existing criteria, while the Discussion says this Delphi exercise produced candidate items, not final criteria. The paper therefore does not establish that inclusion in the final criteria was largely based on expert opinion. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPositive anti-dsDNA antibodies received the highest Delphi score (8.94) which determined the highest score (6 points) in the weighted scoring of the disease.
“In fact, positive anti-dsDNA antibodies received the highest Delphi score (8.94) which determined the highest score (6 points) in the weighted scoring of the disease.”
From Anti-dsDNA antibodies in the classification criteria of systemic lupus erythematosus (2022) · cites this paper as [25]
The Results (Thematic analysis; page unavailable) say 99% of experts considered anti-dsDNA and anti-Sm antibodies the most typical serologic findings of SLE. The Methods describe Delphi appropriateness ratings, but the passages in our copy do not substantiate an anti-dsDNA score of 8.94, a six-point weighted score, or the claim that the former determined the latter. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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Cites
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- Authors
- Schmajuk, G., Hoyer, B. F., Aringer, M., Johnson, S. R., Daikh, D. I., Dörner, T., & the SLE classification criteria steering committee and the international SLE expert panel of the initiative
- Affiliations
- San Francisco VA Medical Center (US)
- German Rheumatism Research Centre (DE)
- University Hospital Carl Gustav Carus (DE)
- Mount Sinai Hospital (CA)
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2018-09-11
- Volume
- 70
- Issue
- 10
- Pages
- 1488-1494
- ISSN
- 0893-7524 (ISSN-L)
- 2151-464X
- 2151-4658
- PMC
- PMC6026087
- OpenAlex
- W2779862955
- Cited by
- 65
- References
- 21
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 11 · 2020: 10 · 2019: 12 · 2018: 3 · 2017: 1
- FWCI
- 6.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23 AR063770)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Pathology and Forensic Medicine › Systemic Sclerosis and Related Diseases
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Keywords
- systemic lupus erythematosus, classification criteria, item generation, item reduction, expert consensus, autoantibodies, antinuclear antibodies, anti-dsDNA antibodies, lupus nephritis, renal manifestations, cutaneous manifestations, organ involvement
- MeSH terms
- Antibodies, Antinuclear, Delphi Technique, Humans, Kidney, Lupus Erythematosus, Systemic
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