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Antiphospholipid syndrome (APS) management needs refinement beyond a one-size-fits-all approach. New classification criteria offer opportunities for subphenotyping and personalized treatment strategies for APS patients.

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Area of Science:

  • Rheumatology
  • Immunology
  • Hematology

Background:

  • Antiphospholipid syndrome (APS) is characterized by thrombotic, non-thrombotic, and obstetric events in individuals with antiphospholipid antibodies (aPL).
  • Current APS clinical management relies on a generalized 'one size fits all' strategy, limited by a scarcity of prospective, controlled studies.
  • Despite progress in phenotyping, a need exists for more personalized management approaches in APS.

Purpose of the Study:

  • To highlight the limitations of current APS management strategies.
  • To introduce the 2023 ACR-EULAR APS classification criteria as a catalyst for change.
  • To advocate for subphenotyping APS based on pathophysiology and unmet clinical needs.

Main Methods:

  • Review of existing literature on APS clinical manifestations and management.
  • Analysis of the implications of the newly published 2023 ACR-EULAR APS classification criteria.
  • Discussion of future research directions informed by pathophysiology and clinical needs.

Main Results:

  • The current 'one size fits all' approach to APS management is suboptimal.
  • The 2023 ACR-EULAR APS classification criteria provide a foundation for rethinking APS.
  • Novel pathophysiology-informed approaches can enable subphenotyping of APS.

Conclusions:

  • The 2023 ACR-EULAR APS classification criteria facilitate a paradigm shift in understanding and managing APS.
  • Future APS research should focus on subphenotyping and addressing unmet clinical needs.
  • Personalized management strategies are essential for improving outcomes in APS patients.