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Are the 1990 American College of Rheumatology vasculitis classification criteria still valid?

Are the 1990 American College of Rheumatology vasculitis classification criteria still valid?
Are the 1990 American College of Rheumatology vasculitis classification criteria still valid?
Objectives: advances in diagnostic techniques have led to better distinction between types of vasculitis, potentially affecting the utility of the 1990 ACR classification criteria for vasculitis. This study tested the performance of these criteria in a contemporary vasculitis cohort.

Methods: The Diagnosis and Classification in Vasculitis Study provided detailed clinical, serological, pathological and radiological data from patients with primary systemic vasculitis and clinical context-specific comparator conditions. Fulfilment of six ACR criteria sets and their diagnostic performance was evaluated in patients with a given type of vasculitis and its comparator conditions.

Results: data from 1095 patients with primary systemic vasculitis and 415 with comparator conditions were available. For classification, sensitivities and specificities for ACR classification criteria were, respectively, 81.1% and 94.9% for GCA; 73.6% and 98.3% for Takayasu’s arteritis; 65.6% and 88.7% for granulomatosis with polyangiitis; 57.0% and 99.8% for eosinophilic granulomatosis with polyangiitis; 40.6% and 87.8% for polyarteritis nodosa; 28.9% and 88.5% for microscopic polyangiitis; and 72.7% and 96.3% for IgA-vasculitis. Overall sensitivity was 67.1%. Of cases identified by their respective criteria, 16.9% also met criteria for other vasculitides. Diagnostic specificity ranged from 64.2 to 98.9%; overall, 113/415 comparators (27.2%) fulfilled at least one of the ACR classification criteria sets.

Conclusion: since publication of the ACR criteria for vasculitis, the sensitivity for each type of vasculitis, except GCA, has diminished, although the specificities have remained high, highlighting the need for updated classification criteria.
1462-0324
1154-1161
Seeliger, B.
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Sznajd, J
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Robson, J.C.
c98e5309-2e5b-4543-b532-ae444448867c
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Craven, A.
fa67cf30-3538-4e92-bd5e-3fdc9657cffa
Grayson, P.
d039a047-4ba3-429b-9da9-5b252c955738
Suppiah, R.S.
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Watts, R.A.
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Merkel, P.A.
7749beaa-bb78-4ea3-992f-be7f1211795b
Luqmani, R.
8ae75ebf-f0db-4d3e-a5de-c3c44ee6cec0
Seeliger, B.
0626caea-180d-4721-b068-db6164191e8d
Sznajd, J
e3bc2c06-008e-4638-b777-bb96c2058d9d
Robson, J.C.
c98e5309-2e5b-4543-b532-ae444448867c
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Craven, A.
fa67cf30-3538-4e92-bd5e-3fdc9657cffa
Grayson, P.
d039a047-4ba3-429b-9da9-5b252c955738
Suppiah, R.S.
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Watts, R.A.
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Merkel, P.A.
7749beaa-bb78-4ea3-992f-be7f1211795b
Luqmani, R.
8ae75ebf-f0db-4d3e-a5de-c3c44ee6cec0

Seeliger, B., Sznajd, J, Robson, J.C., Judge, Andrew, Craven, A., Grayson, P., Suppiah, R.S., Watts, R.A., Merkel, P.A. and Luqmani, R. (2017) Are the 1990 American College of Rheumatology vasculitis classification criteria still valid? Rheumatology, 56 (7), 1154-1161. (doi:10.1093/rheumatology/kex075).

Record type: Article

Abstract

Objectives: advances in diagnostic techniques have led to better distinction between types of vasculitis, potentially affecting the utility of the 1990 ACR classification criteria for vasculitis. This study tested the performance of these criteria in a contemporary vasculitis cohort.

Methods: The Diagnosis and Classification in Vasculitis Study provided detailed clinical, serological, pathological and radiological data from patients with primary systemic vasculitis and clinical context-specific comparator conditions. Fulfilment of six ACR criteria sets and their diagnostic performance was evaluated in patients with a given type of vasculitis and its comparator conditions.

Results: data from 1095 patients with primary systemic vasculitis and 415 with comparator conditions were available. For classification, sensitivities and specificities for ACR classification criteria were, respectively, 81.1% and 94.9% for GCA; 73.6% and 98.3% for Takayasu’s arteritis; 65.6% and 88.7% for granulomatosis with polyangiitis; 57.0% and 99.8% for eosinophilic granulomatosis with polyangiitis; 40.6% and 87.8% for polyarteritis nodosa; 28.9% and 88.5% for microscopic polyangiitis; and 72.7% and 96.3% for IgA-vasculitis. Overall sensitivity was 67.1%. Of cases identified by their respective criteria, 16.9% also met criteria for other vasculitides. Diagnostic specificity ranged from 64.2 to 98.9%; overall, 113/415 comparators (27.2%) fulfilled at least one of the ACR classification criteria sets.

Conclusion: since publication of the ACR criteria for vasculitis, the sensitivity for each type of vasculitis, except GCA, has diminished, although the specificities have remained high, highlighting the need for updated classification criteria.

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More information

Accepted/In Press date: 22 February 2017
e-pub ahead of print date: 31 March 2017
Published date: 1 July 2017

Identifiers

Local EPrints ID: 415046
URI: http://eprints.soton.ac.uk/id/eprint/415046
ISSN: 1462-0324
PURE UUID: 74ed8431-29de-4e9b-a15b-4e3c78bcede9

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Date deposited: 23 Oct 2017 16:31
Last modified: 15 Mar 2024 15:29

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Contributors

Author: B. Seeliger
Author: J Sznajd
Author: J.C. Robson
Author: Andrew Judge
Author: A. Craven
Author: P. Grayson
Author: R.S. Suppiah
Author: R.A. Watts
Author: P.A. Merkel
Author: R. Luqmani

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