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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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2023 ACR/EULAR antiphospholipid syndrome classification criteria.

Medha Barbhaiya1, Stephane Zuily2, Ray Naden3

  • 1Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA.

Annals of the Rheumatic Diseases
|August 28, 2023
PubMed
Summary

New antiphospholipid syndrome (APS) classification criteria offer high specificity for research. Developed by ACR and EULAR, these criteria improve APS diagnosis in observational studies and trials.

Keywords:
antibodies, antiphospholipidantiphospholipid syndromethrombosis

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Area of Science:

  • Rheumatology
  • Immunology
  • Clinical Criteria Development

Background:

  • Antiphospholipid syndrome (APS) requires precise classification criteria for research.
  • Existing criteria may lack specificity for observational studies and clinical trials.

Purpose of the Study:

  • To develop and validate new, highly specific classification criteria for antiphospholipid syndrome (APS).
  • To support the American College of Rheumatology (ACR) and EULAR in establishing updated APS diagnostic standards.

Main Methods:

  • A four-phase international multidisciplinary initiative: criteria generation, reduction, definition with real-world scenarios, and validation.
  • Utilized surveys, literature review, modified Delphi, nominal group technique, multicriteria decision analysis, and independent adjudicator consensus.

Main Results:

  • The 2023 ACR/EULAR APS criteria include entry and weighted additive criteria across clinical and laboratory domains.
  • Achieved 99% specificity and 84% sensitivity in validation, outperforming 2006 Sapporo criteria (86% specificity, 99% sensitivity).
  • APS diagnosis requires ≥3 points from both clinical and laboratory domains.

Conclusions:

  • Rigorous methodology and international input produced new, highly specific ACR/EULAR APS classification criteria.
  • The criteria are hierarchically clustered, weighted, and risk-stratified, reflecting current understanding of APS.
  • These criteria provide a robust foundation for future APS research and clinical trials.