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AB0561 Needs-Assessment Survey for the Update of the Current Antiphospholipid Syndrome (APS) Classification Criteria
  1. M. Barbhaiya1,
  2. M. Abreu2,
  3. M.C. Amigo3,
  4. T. Avcin4,
  5. M.L. Bertolaccini5,
  6. W. Branch6,
  7. P.G. de Groot7,
  8. G. de Jesus8,
  9. R. Levy8,
  10. M. Lockshin9,
  11. M. Tektonidou10,
  12. D. Wahl11,
  13. R. Willis12,
  14. S. Zuily11,
  15. K. Costenbader1,
  16. D. Erkan9
  1. 1Brigham and Women's Hospital, Boston, United States
  2. 2Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
  3. 3ABC Medical Center, Mexico City, Mexico
  4. 4Ljubljana University Medical Centre, Ljubljana, Slovenia
  5. 5The Rayne Institute, King's College, London, United Kingdom
  6. 6University of Utah, Salt Lake City, United States
  7. 7University Medical Centre, Utrecht, Netherlands
  8. 8Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
  9. 9Barbara Volcker Center for Women and Rheumatic Diseases, Hospital For Special Surgery, New York, United States
  10. 10University of Athens, Athens, Greece
  11. 11Nancy University, Nancy, France
  12. 12University of Texas Medical Branch, Galveston, United States

Abstract

Background Currently, the classification of APS is based on clinical and laboratory criteria originally published in 1999 (Sapporo classification) [1] and updated in 2006 [2].

Objectives To assess the need for new APS classification criteria.

Methods Based on the Task Force (TF) reports of the 14th International Congress on Antiphospholipid Antibodies (aPL) (September 2013, Rio de Janeiro, Brazil), a new Task Force on “APS Diagnostic and Classification Criteria” has been created under the auspices of the 15th International Congress on aPL (September 2016, Istanbul, Turkey). Members were selected based on their roles as chairs of previous TFs or interested scientific planning committee members. The chairs of this new TF designed a 14-question needs-assessment survey, which was emailed to 13 members in August 2014. Responses were analyzed anonymously in a descriptive fashion.

Results Survey response rate was 100%. 92% of survey participants reported the need for new ACR classification criteria; 100% agreed that all disease domains are not sampled by current criteria, particularly related to non-criteria APS manifestations; 85% reported scenarios in which current criteria disagree with expert diagnoses; and 62% agreed that other aPL tests should be part of the criteria. Scenarios in which expert diagnoses disagreed with current criteria included: 1) patients with non-criteria manifestations only (with or without positive aPL tests); 2) non-criteria obstetrical findings in patient with positive aPL tests; 3) high suspicion for APS in patients with lack of “persistence” of aPL tests, or negative to low titer aPL tests. Major limitations of the current criteria reported by the responders included: 1) no inclusion of non-criteria clinical manifestations and aPL tests; 2) no evidence based pregnancy morbidity definition; 3) no risk stratification based on aPL-profiles and other co-morbidities; and 4) unclear definition of aPL “persistence”.

Conclusions Broad consensus exists among surveyed international APS physician scientists regarding the need for new APS classification criteria. Based on these findings, the Task Force on APS Diagnostic and Classification Criteria is spearheading an effort to prepare new APS Classification Criteria.

References

  1. Wilson W, Gharavi A, Koike T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 1999; 42: 1309–11.

  2. Miyakis S, Lockshin M, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295–306.

Disclosure of Interest M. Barbhaiya: None declared, M. Abreu: None declared, M. Amigo: None declared, T. Avcin: None declared, M. Bertolaccini: None declared, W. Branch: None declared, P. de Groot Grant/research support from: Thrombosestichting, the Netherlands, Consultant for: SynapseBV, Maastricht, the Netherlands, G. de Jesus: None declared, R. Levy: None declared, M. Lockshin: None declared, M. Tektonidou: None declared, D. Wahl: None declared, R. Willis Employee of: Louisville APL DIagnostic Inc., S. Zuily: None declared, K. Costenbader: None declared, D. Erkan: None declared

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