{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T02:39:06Z","timestamp":1783478346987,"version":"3.55.0"},"reference-count":219,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>The basic initiative related to this study is derived from the fact that systemic lupus erythematosus (SLE) is a unique and fertile <jats:italic>system science<\/jats:italic> subject. We are, however, still far from understanding its nature. It may be fair to indicate that we are spending more time and resources on studying the complexity of <jats:italic>classified<\/jats:italic> SLE than studying the validity of classification criteria. This study represents a theoretical analysis of current instinctual<jats:xref><jats:sup>1<\/jats:sup><\/jats:xref> SLE classification criteria based on \u201cthe causality principle.\u201d The discussion has its basis on the radical scientific traditions introduced by Robert Koch and Louis Pasteur. They announced significant changes in our thinking of disease etiology through the implementation of the modern version of \u201cthe causality principle.\u201d They influenced all aspects of today\u2019s medical concepts and research: <jats:italic>the transformation of medical science from studies of symptoms to study their causes<\/jats:italic>, relevant for monosymptomatic diseases as for syndromes. Their studies focused on bacteria as causes of infectious diseases and on how the immune system adapts to control and prevent contagious spreading. This is the most significant paradigm shift in the modern history of medicine and resulted in radical changes in our view of the immune system. They described <jats:italic>acquired post-infection immunity<\/jats:italic> and <jats:italic>active immunization by antigen-specific vaccines<\/jats:italic>. The paradigm \u201ctransformation\u201d has a great theoretical impact also on current studies of autoimmune diseases like SLE: <jats:italic>symptoms and their cause(s)<\/jats:italic>. In this study, the evolution of SLE classification and diagnostic criteria is discussed from \u201cthe causality principle\u201d perspective, and if contemporary SLE classification criteria are as useful as believed today for SLE research. This skepticism is based on the fact that <jats:italic>classification criteria are not selected based on cogent causal strategies<\/jats:italic>. The SLE classification criteria do not harmonize with Koch\u2019s and Pasteur\u2019s causality principle paradigms and not with Witebsky\u2019s Koch-derived postulates for autoimmune and infectious diseases. It is not established whether the classification criteria can separate SLE as a \u201cone disease entity\u201d from \u201cSLE-like non-SLE disorders\u201d\u2014the latter in terms of SLE imitations. This is discussed here in terms of weight, rank, and impact of the classification criteria: Do they all originate from \u201cone basic causal etiology\u201d? Probably not.<\/jats:p>","DOI":"10.3389\/fimmu.2024.1346619","type":"journal-article","created":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T04:41:36Z","timestamp":1706762496000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["The greatest contribution to medical science is the transformation from studying symptoms to studying their causes\u2014the unrelenting legacy of Robert Koch and Louis Pasteur\u2014and a causality perspective to approach a definition of SLE"],"prefix":"10.3389","volume":"15","author":[{"given":"Ole Petter","family":"Rekvig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,2,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra071297","article-title":"Systemic lupus erythematosus","volume":"358","author":"Rahman","year":"2008","journal-title":"N Engl J 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