The committee agreed not to count a feature when it is more likely due to another condition and to create weighted criteria. Example: Manifestations, such as lupus nephritis, carry a higher score than less common skin features. If the score is 10 or higher, the patient is classified as having SLE.
Rigorous, Detailed Process
The committee wanted to reduce bias and circular reasoning, which could affect the criteria’s validity and viability, said co-chair Sindhu Johnson, MD, PhD, director of the scleroderma program at the University of Toronto.3 In the past, the same experts derived the criteria and then submitted cases to test them, she said. Separate panels of international experts, including rheumatologists, dermatologists, nephrologists and pediatricians, were recruited for each phase. SLE patients were surveyed to find out what symptoms they experienced early in their disease.
Experts nominated criteria that distinguish early from established disease. “We also asked them to think more broadly: Could these criteria also be used for juvenile-onset SLE? Or to identify established disease, but also early disease?” said Dr. Johnson. They found that manifestations of both early and established SLE, such as autoantibodies, specific renal features and skin manifestations, are also seen in mimickers. In addition, 85% of the experts said they would positively classify a patient if renal pathology alone showed lupus nephritis.