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Multicenter Delphi Exercise to Identify Important Key Items for Classifying Systemic Lupus Erythematosus.

Gabriela Schmajuk1, Bimba F Hoyer2, Martin Aringer3

  • 1University of California, San Francisco, and the Department of Veterans Affairs Medical Center, San Francisco.

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Experts developed 40 candidate criteria for classifying systemic lupus erythematosus (SLE). Key features include autoantibodies, renal, and skin manifestations, with lupus nephritis being a strong indicator for SLE classification.

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Area of Science:

  • Rheumatology
  • Immunology
  • Clinical Medicine

Background:

  • Systemic lupus erythematosus (SLE) classification requires updated criteria.
  • The American College of Rheumatology and European League Against Rheumatism initiated a project to reevaluate SLE classification.

Purpose of the Study:

  • To generate and select items for a new classification system for SLE.
  • To establish a broadly representative view of current SLE classification approaches.

Main Methods:

  • A two-step Delphi process involving international lupus expert clinicians.
  • Web-based surveys were used for item generation, rating, and selection.
  • 135 and 147 experts participated in item generation and reduction, respectively.

Main Results:

  • 145 initial items were reduced to 40 candidate criteria for SLE classification.
  • Key features identified include autoantibodies, renal, and skin manifestations.
  • A majority of experts (51%) considered one organ system sufficient with specific lab features; 85% would classify SLE based on lupus nephritis alone.

Conclusions:

  • A set of 40 candidate criteria for SLE classification was established through a Delphi exercise.
  • This study involved the largest expert panel to date for developing SLE criteria.
  • The findings provide a representative view of current SLE classification practices.