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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 [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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Aletaha, D., Neogi, T., Silman, A. J., Funovits, J., Felson, D. T., Bingham, C. O., Birnbaum, N. S., Burmester, G. R., Bykerk, V. P., Cohen, M. D., et al. (2010) · Arthritis & Rheumatism · doi:10.1002/art.27584 · Cited by 9,631
Self-citationWolfe, F., Clauw, D. J., Fitzcharles, M., Goldenberg, D. L., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., Winfield, J. B., & Yunus, M. B. (2010) · Arthritis Care & Research · doi:10.1002/acr.20140 · Cited by 3,952
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Self-citationDougados, M., van der Linden, S., Juhlin, R., Huitfeldt, B., Amor, B., Călin, A., Cats, A., Dijkmans, B. A. C., Olivieri, I., Pasero, G., et al. (1991) · Arthritis & Rheumatism · doi:10.1002/art.1780341003 · Cited by 2,283
Preliminary criteria for the classification of the acute arthritis of primary gout
Wallace, S. L., Robinson, H., Masi, A. T., Decker, J. L., McCarty, D. J., & Yű, T.-F. (1977) · Arthritis & Rheumatism · doi:10.1002/art.1780200320 · Cited by 1,433
Dasgupta, B., Cimmino, M. A., Kremers, H. M., Schmidt, W., Schirmer, M., Salvarani, C., Bachta, A., Dejaco, C., Duftner, C., Jensen, H. S., et al. (2012) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2011-200329 · Cited by 676
Dasgupta, B., Cimmino, M. A., Kremers, H. M., Schmidt, W., Schirmer, M., Salvarani, C., Bachta, A., Dejaco, C., Duftner, C., Jensen, H. S., et al. (2012) · Arthritis & Rheumatism · doi:10.1002/art.34356 · Cited by 411
Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders
Maricq, H. R., LeRoy, E. C., D’Angelo, W., Medsger, T. A., Rodnan, G. P., Sharp, G. C., & Wolfe, J. (1980) · Arthritis & Rheumatism · doi:10.1002/art.1780230208 · Cited by 400
Rao, J. K., Allen, N. B., & Pincus, T. (1998) · Annals of Internal Medicine · doi:10.7326/0003-4819-129-5-199809010-00001 · Cited by 338
Research works printed but not linked: 1
- Panush RS, 1997, It is lupus?, Bull Rheum Dis, 46, 3
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Aringer, M., Costenbader, K., Daikh, D., Brinks, R., Mosca, M., Ramsey‐Goldman, R., Smolen, J. S., Wofsy, D., Boumpas, D. T., Kamen, D. L., et al. (2019) · Arthritis & Rheumatology · doi:10.1002/art.40930 · Cited by 2,677
Self-citationSmolen, J. S., Aletaha, D., Barton, A. C., Burmester, G. R., Emery, P., Firestein, G. S., Kavanaugh, A., McInnes, I. B., Solomon, D. H., Strand, V., et al. (2018) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2018.1 · Cited by 2,534
Self-citationDiagnosis and Management of Rheumatoid Arthritis
Aletaha, D., & Smolen, J. S. (2018) · JAMA · doi:10.1001/jama.2018.13103 · Cited by 2,366
Self-citation2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria
Wolfe, F., Clauw, D. J., Fitzcharles, M.-A., Goldenberg, D. L., Häuser, W., Katz, R. L., Mease, P. J., Russell, A. S., Russell, I. J., & Walitt, B. (2016) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2016.08.012 · Cited by 2,232
Aringer, M., Costenbader, K., Daikh, D., Brinks, R., Mosca, M., Ramsey-Goldman, R., Smolen, J. S., Wofsy, D., Boumpas, D. T., Kamen, D. L., et al. (2019) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2018-214819 · Cited by 1,612
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Metadata
- 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
- 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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