A critical look at disease classification/diagnosis criteria in rheumatology

Multiple sets of classification/diagnostic criteria have been revised recently in rheumatology, with issues from why to how they were developed coming to light. These issues range from the worse specificity of the new sets of criteria to methodological issues in their development, including the use of incorrect validation cohorts. These have potentially had a negative impact on clinical care and research. It needs to be acknowledged that insight into basic disease mechanisms in many of our diseases is incomplete. Hence, there may be a need to focus less on designing criteria for these diseases and instead focus more on preparing guidelines with the same methodological rigor that current insights into these conditions enable us to. Furthermore, the frequency with which these guidelines are prepared is all-important when they are utilized for either clinical care or research.