#3-97E. The Sensitivity Gap: Evaluating the 2023 ACR/EULAR Criteria in oAPS (ACR, 2025)

Do the updated classification criteria for obstetric antiphospholipid syndrome (oAPS) truly reflect real-world clinical risks? In today’s episode, we review a multicenter retrospective cohort study of 122 women with primary oAPS that evaluated the sensitivity of the new 2023 ACR/EULAR criteria. The researchers observed a striking drop in diagnostic sensitivity, which plummeted to merely 23% under the new guidelines compared to 75.4% with the legacy 2006 Sydney criteria. The most crucial finding suggests that the stringent new criteria may fail to identify patients who remain at risk for future obstetric complications, raising the alarm that misusing these criteria as strict diagnostic tools could lead to perilous undertreatment. However, when critically appraising this paper, we must note the lack of a control group—which precludes the evaluation of specificity—as well as inherent biases from missing data typical of a retrospective design. For clinicians, this underscores a vital caveat: rigid reliance on formal classification criteria for daily diagnosis can be hazardous, and individualized clinical judgment tailored to each patient's unique risk profile remains paramount in safely managing oAPS.

Citation: Ruffilli Francesca, et al. Assessing the sensitivity and the clinical impact of the 2023 ACR/EULAR classification criteria in Obstetric Antiphospholid Syndrome: findings from a multicenter Italian cohort with a long-term follow-up. ACR Journals. 2025. DOI: 10.1002/acr.80040

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.