Distinctions between diagnostic and classification criteria?
Open accessAbstract
Rheumatologists face unique challenges in discriminating between rheumatologic and non-rheumatologic disorders with similar manifestations, and in discriminating among rheumatologic disorders with shared features. The majority of rheumatic diseases are multisystem disorders with poorly understood etiology; they tend to be heterogeneous in their presentation, course, and outcome, and do not have a single clinical, laboratory, pathological, or radiological feature that could serve as a “gold standard” in support of diagnosis and/or classification. Thus, the development of criteria for use in routine clinical care and in clinical research has been an important focus in rheumatology. Improved understanding of disease pathogenesis and new diagnostic tools have led to reexamination of existing classification and diagnostic criteria with updated classification criteria for some diseases being endorsed recently (1, 2). The American College of Rheumatology (ACR) Subcommittee on Classification and Response Criteria is responsible for guiding the development and validation of new classification and response criteria that are eventually considered for ACR endorsement. This includes review of proposals for the development of new criteria sets and providing the ACR leadership with recommendations for development and approval of new classification and response criteria sets (1, 3–5). The Subcommittee has previously published a guidance paper for the development of classification and response criteria (6). This prior work has provided details about the rationale for the ACR’s position on classification criteria, but clarification around the issue of diagnostic criteria was lacking. Indeed, the ACR endorsed preliminary diagnostic criteria for fibromyalgia (7) in 2010, which prompted discussions about whether the Subcommittee should also support the development and ACR endorsement of diagnostic criteria, in addition to that of classification and response criteria. The primary objectives of this current article, by former and current members of the Subcommittee on Classification and Response Criteria, are to compare diagnostic and classification criteria, using specific examples from the published literature, and to clarify the ACR’s position on both types of criteria.
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Classification criteria are primarily intended to create a more homogeneous group of patients for clinical research purposes, thus privileging specificity even at loss of sensitivity.
“classification criteria are primarily intended to create a more homogeneous group of patients for clinical research purposes [12], thus privileging specificity even at loss of sensitivity.”
From Anti-dsDNA antibodies in the classification criteria of systemic lupus erythematosus (2022) · cites this paper as [12]
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Introduction, epidemiology and classification of vasculitis
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A scoping review of how early-stage knee osteoarthritis has been defined
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Seronegative autoimmune diseases: A challenging diagnosis
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A Statement of the MDS on Biological Definition, Staging, and Classification of Parkinson's Disease
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Toward new criteria for systemic lupus erythematosus-a standpoint
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Classification Criteria for Sarcoidosis-Associated Uveitis
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Classification Criteria for Acute Retinal Necrosis Syndrome
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Classifying Cam Morphology by the Alpha Angle: A Systematic Review on Threshold Values
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Ankylosing Spondylitis and Axial Spondyloarthritis
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Classification Criteria for Behçet Disease Uveitis
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Classification Criteria for Birdshot Chorioretinitis
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Classification Criteria for Tubercular Uveitis
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Recognizing Axial Spondyloarthritis: A Guide for Primary Care
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An Algorithm for the Diagnosis of Behçet Disease Uveitis in Adults
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Undifferentiated connective tissue disease: state of the art on clinical practice guidelines
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Classification Criteria for Cytomegalovirus Retinitis
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Martos, J. L., Lilleker, J. B., Parker, M. J. S., McHugh, N. J., & Chinoy, H. (2020) · Rheumatology · doi:10.1093/rheumatology/keaa801 · Cited by 70 · see citing works
Casal-Domínguez, M., Pinal‐Fernandez, I., Pak, K. S., Huang, W., Selva-O’Callaghan, A., Albayda, J., Casciola-Rosen, L. A., Paik, J. J., Tiniakou, E., Mecoli, C. A., et al. (2021) · Arthritis & Rheumatology · doi:10.1002/art.41964 · Cited by 69 · see citing works
Classification criteria for diffuse idiopathic skeletal hyperostosis: a lack of consensus
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Defining Severity in Alopecia Areata: Current Perspectives and a Multidimensional Framework
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Self-citationNew classification criteria for systemic lupus erythematosus
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Ariyawardana, A., Chmieliauskaite, M., Farag, A. M., Albuquerque, R., Forssell, H., Nasri‐Heir, C., Klasser, G. D., Sardella, A., Mignogna, M. D., Ingram, M., et al. (2019) · Oral Diseases · doi:10.1111/odi.13067 · Cited by 64 · see citing works
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Neurologic Manifestations of the Antiphospholipid Syndrome — an Update
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Diagnosis and differential diagnosis of large-vessel vasculitides
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Criteria for Early-Phase Diffuse Idiopathic Skeletal Hyperostosis: Development and Validation
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Classification Criteria for Multifocal Choroiditis With Panuveitis
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Classification Criteria for Punctate Inner Choroiditis
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Classification Criteria For Multiple Evanescent White Dot Syndrome
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- Authors
- Aggarwal, R., Ringold, S., Khanna, D., Neogi, T., Johnson, S. R., Miller, A., Brunner, H. I., Ogawa, R., Felson, D., Ogdie, A., Aletaha, D., & Feldman, B. M.
- Affiliations
- University of Pittsburgh (US)
- Seattle Children's Hospital (US)
- University of Michigan (US)
- Boston University (US)
- Mount Sinai Hospital (CA)
- American College of Rheumatology (US)
- Cincinnati Children's Hospital Medical Center (US)
- University of California, Los Angeles (US)
- University of Pennsylvania (US)
- Medical University of Vienna (AT)
- University of Toronto (CA)
- ORCID
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2015-06-25
- Volume
- 67
- Issue
- 7
- Pages
- 891-897
- ISSN
- 0893-7524 (ISSN-L)
- 2151-464X
- 2151-4658
- PMC
- PMC4482786
- OpenAlex
- W2034534130
- Cited by
- 539
- References
- 36
- Citations by year
- 2026: 31 · 2025: 45 · 2024: 56 · 2023: 51 · 2022: 70 · 2021: 75 · 2020: 55 · 2019: 40 · 2018: 30 · 2017: 41 · 2016: 32 · 2015: 12 · 2012: 1
- FWCI
- 32.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (P60AR047785)
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Rehabilitation › Musculoskeletal Disorders and Rehabilitation
- Keywords
- diagnostic criteria, classification criteria, rheumatoid arthritis, disease classification
- MeSH terms
- Animals, Humans, Rheumatic Diseases, Rheumatology, International Classification of Diseases
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