Scientific article

2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria

Published inArthritis & rheumatology, vol. 75, no. 10, p. 1687-1702
Publication date2023-10
First online date2023-08-28

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 4 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 6 clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and 2 laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β2-glycoprotein I antibodies). Patients accumulating at least 3 points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria versus the 2006 revised Sapporo classification criteria had a specificity of 99% versus 86%, and a sensitivity of 84% versus 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.

NoteThis article is published simultaneously in Annals of the Rheumatic Diseases.
Citation (ISO format)
BARBHAIYA, Medha et al. 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria. In: Arthritis & rheumatology, 2023, vol. 75, n° 10, p. 1687–1702. doi: 10.1002/art.42624
Main files (1)
Article (Published version)
ISSN of the journal2326-5191

Technical informations

Creation08/30/2023 6:46:39 AM
First validation04/05/2024 1:21:53 PM
Update time04/05/2024 1:21:53 PM
Status update04/05/2024 1:21:53 PM
Last indexation05/06/2024 6:19:51 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack