Antiphospholipid syndrome: the need for new international classification criteria

ABSTRACT

Introduction: As soon as the association of lupus anticoagulant (LAC) and anticardiolipin antibodies (aCL) with thrombosis and miscarriages was described in the 1980s, the definition of the antiphospholipid syndrome (APS) became a need. Early descriptions of the disease by members of the Graham Hughes team included broad categories and unexplained laboratory inclusions. Over time, new clinical and experimental data refined the criteria, especially the obstetric manifestations, as well as the laboratory criteria.

Areas covered: The authors performed a review of the literature using the PubMed database, and the following keywords were used: ‘antiphospholipid antibody’, ‘antiphospholipid syndrome’, and ‘criteria of antiphospholipid’. The history of antiphospholipid criteria, clinical and experimental advancements, and other expert opinions were included in this paper.

Expert opinion: It has been 14 years since an international congress on antiphospholipid antibodies has generated new classification based on the recent extensive research performed in the field. Currently, there is a need to update the international APS classification taking into consideration the inclusion of new clinical criteria such as aPL-related nephropathy as well as new standardized antibody specificities (e.g., anti-phosphatidylserine/prothrombin antibodies) with the adoption of a standardized scoring system that can stratify APS patients.

KEYWORDS:

• Antiphospholipid syndrome
• history
• classifications
• advancements
• experimental research

Article highlights

• The association of antiphospholipid antibodies with thrombosis and miscarriages started to be highlighted in the 1980s.

• After the initial international symposia on antiphospholipid antibodies, several experts started suggesting classification criteria for antiphospholipid syndrome.

• The classification criteria kept on improving until 2006 when the Sydney criteria were proposed.

• Since 2006, extensive investigations have found a potentially very valuable role in new antibody specificities, such as anti-phosphatidylserine/prothrombin antibodies.

• One of the scoring systems that has been proposed to stratify antiphospholipid syndrome patients based on their clinical and laboratory profile could be incorporated into the new classification criteria.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.