BACKGROUND: The classification of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and polyarteritis nodosa (PAN) for epidemiology studies is confusing. The existing schemes such as American College of Rheumatology (ACR) criteria, Chapel Hill Consensus Conference (CHCC) definitions and Lanham criteria produce overlapping and conflicting classifications, making it difficult to compare incidence figures. AIM: To develop a consensus method of using these criteria and definitions for epidemiological studies to permit comparison without confounding by classification. METHODS: A stepwise algorithm was developed by consensus between a group of doctors interested in the epidemiology of vasculitis. The aim was to categorise patients with Wegener's granulomatosis, microscopic polyangiitis (MPA), Churg-Strauss syndrome (CSS) and PAN into single clinically relevant categories. The ACR and Lanham criteria for CSS, and ACR criteria for Wegener's granulomatosis were applied first, as these were considered to be the most specific. Surrogate markers for Wegener's granulomatosis were included to distinguish Wegener's granulomatosis from MPA. MPA was classified using the CHCC definition and surrogate markers for renal vasculitis. Finally, PAN was classified using the CHCC definition. The algorithm was validated by application to 20 cases from each centre and 99 from a single centre, followed by a paper case exercise. RESULTS: A four-step algorithm was devised. It successfully categorises patients into a single classification. There was good correlation between observers in the paper case exercise (91.5%; unweighted kappa = 0.886). CONCLUSION: The algorithm achieves its aim of reliably classifying patients into a single category. The use of the algorithm in epidemiology studies should permit comparison between geographical areas.
BACKGROUND: The classification of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and polyarteritis nodosa (PAN) for epidemiology studies is confusing. The existing schemes such as American College of Rheumatology (ACR) criteria, Chapel Hill Consensus Conference (CHCC) definitions and Lanham criteria produce overlapping and conflicting classifications, making it difficult to compare incidence figures. AIM: To develop a consensus method of using these criteria and definitions for epidemiological studies to permit comparison without confounding by classification. METHODS: A stepwise algorithm was developed by consensus between a group of doctors interested in the epidemiology of vasculitis. The aim was to categorise patients with Wegener's granulomatosis, microscopic polyangiitis (MPA), Churg-Strauss syndrome (CSS) and PAN into single clinically relevant categories. The ACR and Lanham criteria for CSS, and ACR criteria for Wegener's granulomatosis were applied first, as these were considered to be the most specific. Surrogate markers for Wegener's granulomatosis were included to distinguish Wegener's granulomatosis from MPA. MPA was classified using the CHCC definition and surrogate markers for renal vasculitis. Finally, PAN was classified using the CHCC definition. The algorithm was validated by application to 20 cases from each centre and 99 from a single centre, followed by a paper case exercise. RESULTS: A four-step algorithm was devised. It successfully categorises patients into a single classification. There was good correlation between observers in the paper case exercise (91.5%; unweighted kappa = 0.886). CONCLUSION: The algorithm achieves its aim of reliably classifying patients into a single category. The use of the algorithm in epidemiology studies should permit comparison between geographical areas.
Authors: R Y Leavitt; A S Fauci; D A Bloch; B A Michel; G G Hunder; W P Arend; L H Calabrese; J F Fries; J T Lie; R W Lightfoot Journal: Arthritis Rheum Date: 1990-08
Authors: J F Fries; G G Hunder; D A Bloch; B A Michel; W P Arend; L H Calabrese; A S Fauci; R Y Leavitt; J T Lie; R W Lightfoot Journal: Arthritis Rheum Date: 1990-08
Authors: A T Masi; G G Hunder; J T Lie; B A Michel; D A Bloch; W P Arend; L H Calabrese; S M Edworthy; A S Fauci; R Y Leavitt Journal: Arthritis Rheum Date: 1990-08
Authors: David Jayne; Niels Rasmussen; Konrad Andrassy; Paul Bacon; Jan Willem Cohen Tervaert; Jolanta Dadoniené; Agneta Ekstrand; Gill Gaskin; Gina Gregorini; Kirsten de Groot; Wolfgang Gross; E Christiaan Hagen; Eduardo Mirapeix; Erna Pettersson; Carl Siegert; Alberto Sinico; Vladimir Tesar; Kerstin Westman; Charles Pusey Journal: N Engl J Med Date: 2003-07-03 Impact factor: 91.245
Authors: Judy Savige; Wayne Dimech; Marvin Fritzler; James Goeken; E Chris Hagen; J Charles Jennette; Rob McEvoy; Charles Pusey; Wendy Pollock; Michelle Trevisin; Allan Wiik; Richard Wong Journal: Am J Clin Pathol Date: 2003-09 Impact factor: 2.493
Authors: R W Lightfoot; B A Michel; D A Bloch; G G Hunder; N J Zvaifler; D J McShane; W P Arend; L H Calabrese; R Y Leavitt; J T Lie Journal: Arthritis Rheum Date: 1990-08
Authors: Sang-Won Lee; Do Young Kim; Sang Hoon Ahn; Yong-Beom Park; Kwang-Hyub Han; Jun Yong Park Journal: Rheumatol Int Date: 2018-05-12 Impact factor: 2.631
Authors: Jae Yeon Kim; Hyeok Choi; Minyoung Kevin Kim; Soo Bin Lee; Yong-Beom Park; Sang-Won Lee Journal: Rheumatol Int Date: 2019-08-01 Impact factor: 2.631