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Even if we agree with the conclusions of Narain et al¹ that systemic autoimmune diseases are often misdiagnosed in primary care settings, exposing some of these patients to receive toxic medications, we think that the methods used do not support this assertion because of several important limitations. First, the patients were examined by 1 of 4 clinicians, of whom 2 were also the experts who decided on the final diagnosis. A correct procedure should have been an independent panel not implicated in the patient’s care deciding on the definitive diagnosis.

Second, some of the criteria used by the authors as gold standards to affirm the diagnosis of systemic diseases are in fact classification criteria and not diagnosis criteria. Besides the criticisms that can be made on the methods used to establish these criteria (eg, frequent selection bias due to the participation of reference centers and questionable control population), these studies . . . [Full Text of this Article]

AUTHOR INFORMATION
Bernard Goichot, MD, PhD; Stéphane Vinzio, MD

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