Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Criteria for the classification of SLE are being developed with the support of EULAR and ACR. Two independent exercises (expert-based Delphi exercise and data-driven cohort evaluation of early SLE and controls) were undertaken to generate candidate criteria, and then reduce them to a smaller set. The objective of this study was to select a set of items that maximizes the likelihood of accurate classification of SLE, particularly early disease.
Methods: In the Delphi exercise, 120 international SLE experts proposed 196 items useful for the classification of a broad spectrum of SLE, including early and late stage disease.1 Features distinguishing early SLE (<3 years) and controls were also evaluated in a cohort from 2 European and 2 North American centers.2 The candidate criteria were rated, and low ranking and redundant criteria were removed, leaving 41 criteria.1An independent panel of seven international SLE experts (reflecting practice in Spain, France, Germany, United States, Canada and Mexico) was asked to rank the 41 candidate criteria. The ranking was presented at a face-to-face meeting of the expert panel and steering committee. 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 41 to 21. The panel distinguished potential “entry criteria”, which would be required for classification, from other potential “additive criteria”, summarized in Table 1. Potential entry criteria were ‘ANA ≥1:80 (by 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. Table 1. Additive Criteria
|Lupus nephritis by renal biopsy with immune deposits|
|Rash with dermoepidermal interface changes and/or immunoglobulin and/or complement deposition on immunofluorescence|
|Presence of multiple autoantibodies*|
|Anti-phospholipid antibodies (lupus anti-coagulant, anti-cardiolipin, anti-beta2GPI, or prolonged RVVT)|
|Leukopenia (<4000/mm3 on 2 or more occasions)|
|Thrombocytopenia <100,000 on 2 or more occasions|
|Autoimmune hemolytic anemia|
|Active urine sediment (without UTI)|
|Persistent proteinuria (≥0.5g/day)|
|Acute cutaneous lupus: SLICC definition (includes subacute cutaneous lupus)|
|Chronic cutaneous lupus: SLICC definition|
|Alopecia with associated scalp inflammation|
|Serositis (pleural, pericardial effusion, pleurisy, pericarditis, peritonitis)|
|Oral mucosal lesions on the hard palate|
|CNS manifestations (seizures, psychosis, chorea, myelitis, optic neuritis, stroke or acute confusional state)|
* to be defined. Additional work is needed to refine definitions, to evaluate their independence and relationships within domains, and to ascertain item weights.
Conclusion: The expert panel’s NGT exercise resulted in 21 candidate SLE classification criteria. Refinement of definitions, ability to cluster criteria into domains and weighting of criteria will be ascertained in the next phase. References: 1 Hoyer BF, Schmajuk G, Aringer M, et al. Multi-Center Delphi Exercise Reveals Important Key Items in Classifying SLE. Arthritis Rheumatol.2015; 67 (suppl 10). 2 Mosca M, Touma Z, Costenbader KH, et al. How Do Patients with Newly Diagnosed SLE Present? A Multicenter Cohort Analysis to Inform the Development of New Classification Criteria for SLE. Arthritis Rheumatol. 2015; 67 (suppl 10).
To cite this abstract in AMA style:Johnson SR, Khanna D, Cervera R, Costedoat-Chalumeau N, Gladman DD, Hahn BH, Hiepe F, Sanchez-Guerrero J, Massarotti E, Boumpas D, Costenbader KH, Daikh DI, Jayne D, Dörner T, Kamen DL, Mosca M, Ramsey-Goldman R, Smolen JS, Wofsy D, Aringer M. Use of Nominal Group Technique to Determine Candidate Items for SLE Classification Criteria Development [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/use-of-nominal-group-technique-to-determine-candidate-items-for-sle-classification-criteria-development/. Accessed November 12, 2019.
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