Causation-based SLE diagnostic criteria should replace advance-repressing SLE classification criteria

Systemic lupus erythematosus (SLE) presents with diverse clinical manifestations originating from multiple contributing factors employing a complex array of pathogenetic pathways. Understanding the origin of the disease is stifled by the assumption that a set of classification criteria represent one disease. Efforts to continuously refine the SLE classification criteria over the last 50 years have been based on the assumption that they will solve core aspects of SLE. Yet, this optimism has failed to deliver, because it is not possible to conquer a complex disease through criteria which are arbitrarily selected, but not supported by causal mechanisms. We propose to reconsider the value of SLE classification criteria and contemplate the development of diagnostic criteria directed by causality to bolster research and treatment efforts. This communication proposes that SLE diagnostic criteria should replace SLE classification criteria, at which point SLE will be studied within the context of causality. Such an accomplishment will optimize SLE research and the care of patients with SLE.