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
Fries JF. Disease Criteria for Systemic Lupus Erythematosus. Arch Intern Med. 1984;144(2):252–253. doi:10.1001/archinte.1984.00350140052005
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