New 2023 classification criteria for antiphospholipid syndrome (ACR/EULAR 2023)
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Antiphospholipid syndrome (APS) is a rare autoimmune disease characterized by thromboses and obstetrical morbidity, linked to the presence of antibodies directed against cell membranes. The Sapporo-Sydney classification criteria, in use since 1999 and updated in 2006, had limitations as they did not account for certain symptoms and lacked the ability to stratify based on the biological profile and cardiovascular risk factors. In 2015, an international effort led by the American College of Rheumatology (ACR) and the European Alliance of Associations For Rheumatology (EULAR) aimed to develop new classification criteria for APS. Published in August 2023, these criteria are highly specific and are hierarchically structured, weighted, and stratified based on the patient’s cardiovascular risk and biological profile. They reflect the current state of knowledge about APS, facilitating homogeneous inclusion of patients in scientific studies. These new criteria involve four steps for classifying a patient, including mandatory entry criteria and an assessment of clinical and biological manifestations. They are intended exclusively for research use, with considerations such as the exclusion of rare manifestations and non-specific low antibodies thresholds that may lead to debatable management. In the absence of classification according to the new criteria, the clinician’s judgment remains essential for therapeutic decisions based on current French and international guidelines.
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