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Matters arising
Seronegative antiphospholipid syndrome
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  1. A S M Jawad1
  1. 1Department of Rheumatology, The Royal London Hospital, Bancroft Road, London E1 4DG, UK
  1. Correspondence to:
    Dr A S M Jawad
    alismjawad1hotmail.com
  1. G Hughes2,
  2. M Khamashta2
  1. 2Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London SE1 7EH, UK

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    I agree with Hughes and Khamashta that the use of the term “seronegative antiphospholipid syndrome (APS)” is useful in clinical practice.1 However, the analogy with seronegative rheumatoid arthritis and antinuclear antibody (ANA) negative lupus is not correct. The current criteria for the classification of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) allow the diagnosis of RA or SLE to be made even if the rheumatoid factor or the ANA is negative, and therefore, seronegative RA and ANA negative SLE are embraced within the classification criteria and as such are not separate entities.2–4

    In the case of APS (Hughes’ syndrome), the current preliminary classification criteria do not allow a diagnosis of APS to be made in the absence of at least two positive tests for either anticardiolipin antibodies or lupus anticoagulant at least 6 weeks apart.5 A revised international consensus statement on classification criteria for APS (Hughes’ syndrome) is required to accommodate the seronegative clinical entity.

    References

    1. ↵
      Hughes GRV, Khamashta M. Seronegative antiphospholipid syndrome. Ann Rheum Dis2003;62:1127.
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    2. ↵
      Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum1988;31:315–24.
      OpenUrlPubMedWeb of Science
    3. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus (SLE). Arthritis Rheum 982 25:1271–7.
    4. ↵
      Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [letter]. Arthritis Rheum1997;40:1725.
      OpenUrlPubMedWeb of Science
    5. ↵
      Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette JC et a l. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome. Report of an International Workshop. Arthritis Rheum1999;42:1309–1311.
      OpenUrlCrossRefPubMedWeb of Science

    Authors’ reply

    We take Dr Jawad’s points and agree fully. We also believe that classification criteria are too often wrongly used in diagnosis. Our aim in writing the leader1 was to highlight what we believe to be a not uncommon diagnostic situation—the patient with many of the features of the syndrome in whom tests remain stubbornly negative.

    Reference

    1. ↵
      Hughes GRV, Khamashta M. Seronegative antiphospholipid syndrome. Ann Rheum Dis2003;62:1127.