Uncertainty in medicine and vasculitis

We propose that clinicians/researchers attempt to address the continuing uncertainty of the root causes of the conditions we try to manage, by naming, lumping and criteria-zing. This review will discuss these, what we consider ill-advised attempts, with recent examples.

It is in vogue to call Sjögren's syndrome, Sjögren's disease. This was boosted by popular vote during a recent medical meeting, an unusual mode of coming to agreements in science. Behçet syndrome is still called Behçet disease by many colleagues despite its still mostly undeciphered disease mechanisms and different phenotypes. There have been recent attempts not only to re-lump Behçet syndrome with seronegative spondarthritides but also with Takayasu arteritis. On the other hand, in some instances, Takayasu arteritis can only be differentiated from giant cell arteritis by the age of the patient. Designing classification criteria for various conditions is still popular while criteria proponents maintain they are strictly for research purposes, ignoring the fact that the hypothesis of a research project is the sole determinant of the related criteria. We also maintain that these criteria can be useful for diagnosis and research only as guidelines.

We propose that uncertainty still much present in the practice of medicine should not lead us to resort to naming, lumping and criteria-zing. We have to be more honest and vocal with our patients, our students and everyone involved in providing care for the sick about this inherent uncertainty.