Send to

Choose Destination
Ann Rheum Dis. 2019 May;78(5):634-640. doi: 10.1136/annrheumdis-2018-214685. Epub 2019 Jan 28.

Multicriteria decision analysis process to develop new classification criteria for systemic lupus erythematosus.

Author information

Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Departments of Internal Medicine and Rheumatology, Clinical Immunology and Allergy, University of Crete, Heraklion, Greece.
Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Department of Medicine, VA Medical Center, San Francisco, California, USA.
Department of Medicine/Rheumatology and Clinical Immunology, Charite University Hospitals, Berlin, Germany.
Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Feinstein Institute for Medical Research, Manhasset, New York, USA.
Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Medicine, University of Cambridge, Cambridge, UK.
Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Department of Medicine/Division of Rheumatology, Northwestern University, Chicago, Illinois, USA.
Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, Spain.
Rheumatology Department, University Hospital Dusseldorf, Dusseldorf, Germany.
Department of Rheumatology, Medical University of Vienna, Vienna, Austria.
Department of Medicine, McMaster University, Hamilton, Canada.
Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany.
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.


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.


clinical research; methodology; systemic lupus erythematosus

Free full text

Supplemental Content

Full text links

Icon for HighWire Icon for eScholarship, California Digital Library, University of California
Loading ...
Support Center