Disease Criteria for Systemic Lupus Erythematosus

Presentation of disease "criteria" affirms our ignorance of the essence of a disease. If we understand a disease we can describe the elements that are necessary and sufficient for its diagnosis. One can so define gouty arthritis, in which joint fluid crystals serve as a "gold standard" against which to measure the usefulness of other observations. No other major rheumatic disease, including systemic lupus erythematosus (SLE), has such a standard. Thus, criteria must be constructed in a circular manner, by testing variables against a diagnosis established by intuition. The "best" criteria therefore only describe the current conventional wisdom in an efficient manner. See also p 281. Why then make the effort? Rheumatic disease criteria are designed to (1) enable physicians to use the same language, (2) provide a focal definition for criticism, (3) teach the cardinal features, and (4) raise the diagnostic acuity of the inexperienced toward that of the