Towards improved criteria for the antiphospholipid syndrome.

A workshop to be held in Sapporo will attempt to upgrade criteria for the antiphospholipid syndrome (APS). These criteria should probably be based on a scoring system using both clinical and biological items. Clinical criteria could be categorized between 'major', that is thrombosis or obstetrical criteria, and 'minor', to be selected among livedo, heart valve lesions, chorea, adrenal hemorrhage, thrombocytopenia, and others. A similar approach could be proposed for biological criteria, with persistent strong LA, high IgG aCL or antibodies to beta2GPI as major criteria if the workshop accepts antibodies directed to co-factors as APS criteria. Minor criteria could include IgM aCL, low/medium IgG aCL, and VDRL. Whether anti-prothrombin, anti-oxidised LDL, and M5 anti-mitochondrial antibodies should be added to the minor criteria, is open to discussion. In our mind, other parameters should be taken into account such as: young age--a method to avoid the questionable exclusion of arteriosclerosis in cases of arterial thrombosis--and the presence of personal and/or first-degree familial features of auto-immunity. Lastly, a differential diagnosis section is probably needed.