ArticleRheumatology (Oxford, England)2025
Insights into the 2023 ACR/EULAR antiphospholipid syndrome classification criteria: findings from a cohort of 205 patients with primary APS.
Article in Rheumatology (Oxford, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Do Serologic Domains of the 2023 ACR/EULAR Classification Criteria for Antiphospholipid Syndrome Define Distinct Clinical Subgroups During Pregnancy?International journal of molecular sciences · 2026Article
- Concordance and Relative Performance of the 2023 ACR/EULAR and Revised Sapporo Criteria in Antiphospholipid Syndrome and Analysis of Risk Factors for Recurrent Thrombosis: A Single-Center Cohort Study.Medicina (Kaunas, Lithuania) · 2026Article
- Sharper definitions, blurred lines: The clinical aftermath of the revised antiphospholipid syndrome criteria.HemaSphere · 2026Article
- IgM Antiphospholipid Antibodies in Antiphospholipid Syndrome: Prevalence, Clinical Associations, and Diagnostic Implications-A Scoping Review.Journal of clinical medicine · 2025Review
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Abstract
objectivesThe 2023 American College of Rheumatology / European Alliance of Associations for Rheumatology (ACR/EULAR) antiphospholipid syndrome (APS) classification criteria distinguish between anticardiolipin (aCL) or anti-β2-glycoprotein I (aβ2GPI) IgG vs IgM isotypes, having isolate IgM positivity a low weight, insufficient for APS classification, and define aCL and aβ2GPI thresholds based on fixed cut-off values. We aimed to assess the performance of the 2023 ACR/EULAR criteria in a cohort of primary vascular APS patients (PAPS), previously classified according to the Sydney criteria. Additionally, we evaluated the risk of thrombotic recurrence in patients re-classified or not according to the new criteria.
methodsPAPS patients meeting the Sydney criteria with previous vascular manifestations followed between 1992 and 2023 were re-evaluated to identify cases that would not be classified as PAPS based on the 2023 ACR/EULAR criteria.
resultsOur cohort included 205 PAPS patients: 171 met the ACR/EULAR classification criteria, 34 (16.6%) did not due to insufficient score in the laboratory domain caused by isolate IgM positivity (23 patients) or aPL positivity at a titer >99th percentile but <40 units (11 patients). Notably, 9/34 (26%) patients not confirmed as PAPS had a thrombotic relapse during follow-up. The rate of thrombotic recurrence was similar between patients who fulfilled or not the new criteria.
conclusionAmong PAPS patients classified by Sydney criteria, 16.6% did not meet 2023 ACR/EULAR criteria. One quarter of them had a thrombotic relapse, confirming a pro-thrombotic profile. Inappropriately using these criteria as diagnostic in clinical practice could result in the lack of adequate antithrombotic therapy, exposing these patients to the risk of a new thrombotic event.
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