2023 ACR/EULAR antiphospholipid syndrome classification criteria
Medha Barbhaiya
(1)
,
Stephane Zuily
(2)
,
Ray Naden
(3)
,
Alison Hendry
(4)
,
Florian Manneville
(5)
,
Mary-Carmen Amigo
,
Zahir Amoura
(6)
,
Danieli Andrade
(7)
,
Laura Andreoli
(8)
,
Bahar Artim-Esen
(9)
,
Tatsuya Atsumi
(10)
,
Tadej Avcin
(11)
,
Michael Belmont
(12)
,
Maria Laura Bertolaccini
(13)
,
D Ware Branch
(14)
,
Graziela Carvalheiras
(15)
,
Alessandro Casini
(16)
,
Ricard Cervera
(17)
,
Hannah Cohen
(18)
,
Nathalie Costedoat-Chalumeau
(19)
,
Mark Crowther
(20)
,
Guilherme de Jesús
(21)
,
Aurelien Delluc
(22)
,
Sheetal Desai
(23)
,
Maria De Sancho
(1)
,
Katrien Devreese
(24)
,
Reyhan Diz-Kucukkaya
(9)
,
Ali Duarte-García
(25)
,
Camille Frances
(26)
,
David Garcia
(27)
,
Jean-Christophe Gris
(28)
,
Natasha Jordan
(29)
,
Rebecca Leaf
(30)
,
Nina Kello
(31)
,
Jason Knight
(32)
,
Carl Laskin
(33)
,
Alfred Lee
(34)
,
Kimberly Legault
(20)
,
Steve Levine
(35, 36)
,
Roger Levy
(21, 37)
,
Maarten Limper
(38)
,
Michael Lockshin
(1)
,
Karoline Mayer-Pickel
(39)
,
Jack Musial
(40)
,
Pier Luigi Meroni
(41)
,
Giovanni Orsolini
(42)
,
Thomas Ortel
(43)
,
Vittorio Pengo
(44)
,
Michelle Petri
(45)
,
Guillermo Pons-Estel
(46)
,
Jose Gomez-Puerta
(47)
,
Quentin Raimboug
(48)
,
Robert Roubey
(49)
,
Giovanni Sanna
(50)
,
Surya Seshan
(1)
,
Savino Sciascia
(51)
,
Maria Tektonidou
(52)
,
Angela Tincani
(8)
,
Denis Wahl
(2)
,
Rohan Willis
(53)
,
Cécile Yelnik
(54)
,
Catherine Zuily
(55)
,
Francis Guillemin
(5)
,
Karen Costenbader
(56)
,
Doruk Erkan
(1)
1
Weill Cornell Medicine [Cornell University]
2 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
3 Faculty of Medical and Health Sciences [Auckland]
4 Middlemore Hospital
5 Pôle S2R - Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy]
6 CHU Pitié-Salpêtrière [AP-HP]
7 USP - Universidade de São Paulo = University of São Paulo
8 Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia [Brescia]
9 Istanbul University
10 Hokkaido University Hospital [Sapporo]
11 University of Ljubljana
12 NYU - New York University [New York]
13 KCH - King's College Hospital
14 School of Medicine [University of Utah, Salt Lake City]
15 Centro Hospitalar do Porto
16 HUG - Hôpitaux universitaires de Genève = University Hospitals of Geneva
17 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
18 UCLH - University College London Hospitals
19 Hôpital Cochin [AP-HP]
20 McMaster University [Hamilton, Ontario]
21 UNIRIO - Universidade Federal do Estado do Rio de Janeiro
22 OHRI - Ottawa Hospital Research Institute [Ottawa]
23 UC Irvine - University of California [Irvine]
24 Ghent University Hospital
25 Mayo Clinic [Rochester]
26 CHU Tenon [AP-HP]
27 University of Washington [Seattle]
28 IDESP - Institut Desbrest de santé publique
29 Addenbrooke's Hospital
30 Massachusetts General Hospital [Boston]
31 Northwell Health
32 University of Michigan [Ann Arbor]
33 University of Toronto
34 YSM - Yale School of Medicine [New Haven, Connecticut]
35 Department of Medicine, Division of Rheumatology, Kings County Hospital Center, New York Health and Hospitals, Brooklyn, NY, USA
36 Maimonides Medical Center
37 GlaxoSmithKline
38 UMCU - University Medical Center [Utrecht]
39 TU Graz - Technische Universität Graz
40 UJ - Uniwersytet Jagielloński w Krakowie = Jagiellonian University
41 IAI - Istituto Auxologico Italiano IRCCS Ospedale San Luca [Milan, Italy]
42 UNIVR - Università degli studi di Verona = University of Verona
43 Duke University Medical Center
44 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
45 Johns Hopkins University School of Medicine [Baltimore]
46 GO-Crear - Centro Regional de Enfermedades Autoinmunes y Reumáticas de Grupo Oroño
47 IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer
48 CIC Hôpital Bichat
49 UNC - University of North Carolina [Chapel Hill]
50 Guy's and St Thomas' NHS Foundation Trust
51 UNITO - Università degli studi di Torino = University of Turin
52 NKUA - National and Kapodistrian University of Athens
53 University of Texas Medical Branch at Galveston
54 RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167
55 Service d'Obstétrique et de Gynécologie [CHRU Nancy]
56 Brigham and Women's Hospital [Boston]
2 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
3 Faculty of Medical and Health Sciences [Auckland]
4 Middlemore Hospital
5 Pôle S2R - Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy]
6 CHU Pitié-Salpêtrière [AP-HP]
7 USP - Universidade de São Paulo = University of São Paulo
8 Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia [Brescia]
9 Istanbul University
10 Hokkaido University Hospital [Sapporo]
11 University of Ljubljana
12 NYU - New York University [New York]
13 KCH - King's College Hospital
14 School of Medicine [University of Utah, Salt Lake City]
15 Centro Hospitalar do Porto
16 HUG - Hôpitaux universitaires de Genève = University Hospitals of Geneva
17 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
18 UCLH - University College London Hospitals
19 Hôpital Cochin [AP-HP]
20 McMaster University [Hamilton, Ontario]
21 UNIRIO - Universidade Federal do Estado do Rio de Janeiro
22 OHRI - Ottawa Hospital Research Institute [Ottawa]
23 UC Irvine - University of California [Irvine]
24 Ghent University Hospital
25 Mayo Clinic [Rochester]
26 CHU Tenon [AP-HP]
27 University of Washington [Seattle]
28 IDESP - Institut Desbrest de santé publique
29 Addenbrooke's Hospital
30 Massachusetts General Hospital [Boston]
31 Northwell Health
32 University of Michigan [Ann Arbor]
33 University of Toronto
34 YSM - Yale School of Medicine [New Haven, Connecticut]
35 Department of Medicine, Division of Rheumatology, Kings County Hospital Center, New York Health and Hospitals, Brooklyn, NY, USA
36 Maimonides Medical Center
37 GlaxoSmithKline
38 UMCU - University Medical Center [Utrecht]
39 TU Graz - Technische Universität Graz
40 UJ - Uniwersytet Jagielloński w Krakowie = Jagiellonian University
41 IAI - Istituto Auxologico Italiano IRCCS Ospedale San Luca [Milan, Italy]
42 UNIVR - Università degli studi di Verona = University of Verona
43 Duke University Medical Center
44 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
45 Johns Hopkins University School of Medicine [Baltimore]
46 GO-Crear - Centro Regional de Enfermedades Autoinmunes y Reumáticas de Grupo Oroño
47 IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer
48 CIC Hôpital Bichat
49 UNC - University of North Carolina [Chapel Hill]
50 Guy's and St Thomas' NHS Foundation Trust
51 UNITO - Università degli studi di Torino = University of Turin
52 NKUA - National and Kapodistrian University of Athens
53 University of Texas Medical Branch at Galveston
54 RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167
55 Service d'Obstétrique et de Gynécologie [CHRU Nancy]
56 Brigham and Women's Hospital [Boston]
Medha Barbhaiya
- Fonction : Auteur
- PersonId : 1336713
- ORCID : 0000-0002-6670-7696
Stephane Zuily
- Fonction : Auteur
- PersonId : 807624
- ORCID : 0000-0002-9326-6881
Mary-Carmen Amigo
- Fonction : Auteur
Danieli Andrade
- Fonction : Auteur
- PersonId : 1384486
- ORCID : 0000-0002-0381-1808
Laura Andreoli
- Fonction : Auteur
- PersonId : 1220091
- ORCID : 0000-0002-9107-3218
Michael Belmont
- Fonction : Auteur
- PersonId : 793532
- ORCID : 0000-0003-3389-2976
Nathalie Costedoat-Chalumeau
- Fonction : Auteur
- PersonId : 768024
- ORCID : 0000-0002-1555-9021
Guilherme de Jesús
- Fonction : Auteur
- PersonId : 1336715
- ORCID : 0000-0002-6715-0180
Ali Duarte-García
- Fonction : Auteur
- PersonId : 1220145
- ORCID : 0000-0003-1749-5719
Jean-Christophe Gris
- Fonction : Auteur
- PersonId : 170660
- IdHAL : jean-christophe-gris
- ORCID : 0000-0002-9899-9910
- IdRef : 078631092
Jason Knight
- Fonction : Auteur
- PersonId : 1384488
- ORCID : 0000-0003-0995-9771
Roger Levy
- Fonction : Auteur
- PersonId : 1384489
- ORCID : 0000-0001-6393-6031
Pier Luigi Meroni
- Fonction : Auteur
- PersonId : 1384490
- ORCID : 0000-0002-3394-1451
Giovanni Orsolini
- Fonction : Auteur
- PersonId : 1384491
- ORCID : 0000-0003-4119-3016
Vittorio Pengo
- Fonction : Auteur
- PersonId : 1384492
- ORCID : 0000-0003-2064-6071
Michelle Petri
- Fonction : Auteur
- PersonId : 1336716
- ORCID : 0000-0003-1441-5373
Guillermo Pons-Estel
- Fonction : Auteur
- PersonId : 1315901
- ORCID : 0000-0002-0647-929X
Savino Sciascia
- Fonction : Auteur
- PersonId : 1336696
- ORCID : 0000-0003-1266-9441
Maria Tektonidou
- Fonction : Auteur
- PersonId : 1336718
- ORCID : 0000-0003-2238-0975
Karen Costenbader
- Fonction : Auteur
- PersonId : 1336719
- ORCID : 0000-0002-8972-9388
Doruk Erkan
- Fonction : Auteur
- PersonId : 1336720
- ORCID : 0000-0001-7216-677X
Résumé
Objective. To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. Methods This international multidisciplinary initiative included four phases: (1) Phase I, criteria generation by surveys and literature review; (2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; (3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and (4) Phase IV, validation using independent adjudicators’ consensus as the gold standard. Results. The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1–7 points each) clustered into six clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and two laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti–β 2 -glycoprotein I antibodies). Patients accumulating at least three points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria vs the 2006 revised Sapporo classification criteria had a specificity of 99% vs 86%, and a sensitivity of 84% vs 99%. Conclusion. These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.