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Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies

Published on Aug 11, 2006in Annals of the Rheumatic Diseases14.30
· DOI :10.1136/ard.2006.054593
Richard A. Watts49
Estimated H-index: 49
(UEA: University of East Anglia),
Se Lane14
Estimated H-index: 14
+ 7 AuthorsDavid G. I. Scott30
Estimated H-index: 30
(Norwich University)
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Abstract
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 κ = 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.
  • References (20)
  • Citations (569)
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References20
Newest
Published on Aug 17, 2010in Arthritis & Rheumatism9.00
Robert W. Lightfoot24
Estimated H-index: 24
(UK: University of Kentucky),
Beat A. Michel16
Estimated H-index: 16
(American College of Rheumatology)
+ 11 AuthorsJ. T. Lie15
Estimated H-index: 15
(American College of Rheumatology)
Criteria for the classification of polyarteritis nodosa were developed by comparing 118 patients who had this disease with 689 control patients who had other forms of vasculitis. For the traditional format classification, 10 criteria were selected: weight loss ≥4 kg, livedo reticularis, testicular pain or tenderness, myalgias, mononeuropathy or polyneuropathy, diastolic blood pressure >90 mm Hg, elevated blood urea nitrogen or serum creatinine levels, presence of hepatitis B reactants in serum, ...
Published on Aug 17, 2010in Arthritis & Rheumatism9.00
Alfonse T. Masi47
Estimated H-index: 47
(UIC: University of Illinois at Chicago),
Gene G. Hunder76
Estimated H-index: 76
(American College of Rheumatology)
+ 13 AuthorsRandi Y. Leavitt37
Estimated H-index: 37
(American College of Rheumatology)
Criteria for the classification of Churg-Strauss syndrome (CSS) were developed by comparing 20 patients who had this diagnosis with 787 control patients with other forms of vasculitis. For the traditional format classification, 6 criteria were selected: asthma, eosinophilia >10% on differential white blood cell count, mononeuropathy (including multiplex) or polyneuropathy, non-fixed pulmonary infiltrates on roentgenography, paranasal sinus abnormality, and biopsy containing a blood vessel with e...
Published on Aug 17, 2010in Arthritis & Rheumatism9.00
James R. Fries89
Estimated H-index: 89
(Stanford University),
Gene G. Hunder76
Estimated H-index: 76
(American College of Rheumatology)
+ 13 AuthorsRobert W. Lightfoot24
Estimated H-index: 24
(UK: University of Kentucky)
The Americal College of Rheumatology Subcommittee on Classification of Vasculitis of the Diagnostic and Therapeutic Criteria Committee developed classification criteria for 7 forms of vasculitis: polyarteritis nodosa, Churg-Strauss syndrome, Wegener's granulomatosis, hypersensitivity vasculitis, Henoch-Schonlein purpura, giant cell (temporal) arteritis, and Takayasu arteritis. The data collection methods, quality control, and analytic procedures used to derive the classification rules are discus...
Published on Aug 17, 2010in Arthritis & Rheumatism9.00
Randi Y. Leavitt37
Estimated H-index: 37
(American College of Rheumatology),
Anthony S. Fauci169
Estimated H-index: 169
(American College of Rheumatology)
+ 13 AuthorsRobert W. Lightfoot24
Estimated H-index: 24
(UK: University of Kentucky)
Criteria for the classification of Wegener's granulomatosis (WG) were developed by comparing 85 patients who had this disease with 722 control patients with other forms of vasculitis. For the traditional format classification, 4 criteria were selected: abnormal urinary sediment (red cell casts or >5 red blood cells per high power field), abnormal findings on chest radiograph (nodules, cavities, or fixed infiltrates), oral ulcers or nasal discharge, and granulomatous inflammation on biopsy. The p...
Published on Aug 9, 2006in Rheumatology5.15
Daina Selga10
Estimated H-index: 10
(Lund University),
Aladdin Mohammad13
Estimated H-index: 13
(Lund University)
+ 1 AuthorsMårten Segelmark36
Estimated H-index: 36
(Lund University)
Objectives. Polyarteritis nodosa (PAN) is a term that has been used to describe a wide variety of vasculitic conditions. In 1994, the Chapel Hill Consensus Conference on the nomenclature of systemic vasculitides proposed that the name classical PAN should be restricted to diseases where there is arteritis in small and medium-sized arteries without the involvement of smaller vessels. Our aim was to describe the symptoms and course of disease in PAN when the microscopic forms are excluded. Methods...
Published on Sep 1, 2005in Arthritis & Rheumatism9.00
Cees G. M. Kallenberg80
Estimated H-index: 80
(UMCG: University Medical Center Groningen)
Published on Feb 1, 2005in QJM: An International Journal of Medicine2.65
S.E. Lane1
Estimated H-index: 1
(National Health Service),
Richard A. Watts49
Estimated H-index: 49
+ 1 AuthorsDgi Scott29
Estimated H-index: 29
Background: Wegener's granulomatosis (WG), Churg Strauss syndrome (CSS) and microscopic polyangiitis (MPA) are primary systemic vasculitides (PSV), the clinical features of which have been described from tertiary centres. Aim: To provide the first clinical description of MPA from a general hospital and compare clinical features with WG and CSS. Design: Retrospective analysis of patient records. Methods: Records of 99 PSV patients attending a single hospital, from 1988 to 2000, were reviewed for:...
Published on Sep 1, 2003in American Journal of Clinical Pathology1.96
Judy Savige33
Estimated H-index: 33
,
Wayne Dimech3
Estimated H-index: 3
+ 9 AuthorsMichelle Trevisin7
Estimated H-index: 7
Antineutrophil cytoplasmic antibody (ANCA) tests are used to diagnose and monitor inflammatory activity in Wegener granulomatosis, microscopic polyangiitis and its renal-limited variant (pauci-immune crescentic glomerulonephritis), and Churg-Strauss syndrome. The International Consensus Statement on testing and reporting of ANCA states that ANCA are demonstrated most readily in these conditions by using a combination of indirect immunofluorescence (IIF) of normal peripheral blood neutrophils and...
Published on Jul 3, 2003in The New England Journal of Medicine70.67
David Jayne75
Estimated H-index: 75
,
Niels Rasmussen30
Estimated H-index: 30
+ 16 AuthorsKirsten de Groot21
Estimated H-index: 21
Background The primary systemic vasculitides usually associated with autoantibodies to neutrophil cytoplasmic antigens include Wegener's granulomatosis and microscopic polyangiitis. We investigated whether exposure to cyclophosphamide in patients with generalized vasculitis could be reduced by substitution of azathioprine at remission. Methods We studied patients with a new diagnosis of generalized vasculitis and a serum creatinine concentration of 5.7 mg per deciliter (500 μmol per liter) or le...
Published on Oct 1, 2002in Rheumatology5.15
Se Lane14
Estimated H-index: 14
(Norwich University),
Richard A. Watts49
Estimated H-index: 49
(Norwich University)
+ 1 AuthorsDgi Scott29
Estimated H-index: 29
(Norwich University)
Objectives. To evaluate the use of the diagnostic criteria for Wegener’s granulomatosis (WG) and microscopic polyangiitis (mPA) proposed by Sorensen et al. in the classification of primary systemic vasculitis (PSV). Methods. We applied to our cohort of PSV patients the American College of Rheumatology (ACR) criteria for WG, Churg–Strauss syndrome (CSS) and polyarteritis nodosa (PAN), the Chapel Hill Consensus Conference (CHCC) definitions for WG, mPA and CSS, the Hammersmith criteria for CSS and...
Cited By569
Newest
Published on Dec 1, 2019in BMC Gastroenterology2.25
Hee Jin Park (St Mary's Hospital), Jun Yong Park41
Estimated H-index: 41
(Yonsei University)
+ 3 AuthorsSomin Lee33
Estimated H-index: 33
(Yonsei University)
The fibrosis-4 index (FIB-4) has been reported to be associated with all-cause mortality in several chronic diseases. In this study, we investigated whether at diagnosis could be associated with all-cause mortality in patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). We retrospectively reviewed the medical records of 132 MPA and GPA patients without chronic liver diseases. Conventional risk factors included old age (≥ 65 years), male gender, diabetes mellit...
Published in BMC Infectious Diseases2.56
Makoto Yamaguchi (Aichi Medical University), Takayuki Katsuno8
Estimated H-index: 8
(Aichi Medical University)
+ -3 AuthorsYasuhiko Ito1
Estimated H-index: 1
(Aichi Medical University)
Several studies have identified predictors of severe infections in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). However, the development of oral candidiasis (OC) as a predictor of subsequent severe infections has not been evaluated. The aim of this study was to assess the association between OC and subsequent severe infection requiring hospitalization during immunosuppressive therapy in AAV. This single-center retrospective cohort study included 71 consecutive patients with n...
Published on Feb 4, 2019in BMC Medical Imaging1.62
Sigrun Skaar Holme (University of Oslo), Jon Magnus Moen (Oslo University Hospital)+ 3 AuthorsHeidi B. Eggesbø15
Estimated H-index: 15
(Oslo University Hospital)
Background Even though progressive rhinosinusitis with osteitis is a major clinical problem in granulomatosis with polyangiitis (GPA), there are no studies on how GPA-related osteitis develops over time, and no quantitative methods for longitudinal assessment. Here, we aimed to identify simple and robust CT-based methods for capture and quantification of time-dependent changes in GPA-related paranasal sinus osteitis and compare performance of the methods under study in a largely unselected GPA c...
Published on Mar 8, 2019
Thomas Hellmark25
Estimated H-index: 25
(Lund University),
Sophie Ohlsson12
Estimated H-index: 12
(Lund University)
+ 2 AuthorsÅsa Johansson15
Estimated H-index: 15
(Lund University)
Background Anti-neutrophil cytoplasmic antibodies associated vasculitides (AAV) are characterized by autoimmune small vessel inflammation. Eosinophils are multifunctional cells with both pro-inflammatory and immunoregulatory properties. Tissue activated eosinophils secrete cyto- and chemokines and form extracellular traps (EETs), they release free granules and produce reactive oxygen species. The role of eosinophils is well established in eosinophilic granulomatosis with polyangiitis (EGPA) but ...
Minyoung Kim10
Estimated H-index: 10
(Yonsei University),
Hyeok Choi1
Estimated H-index: 1
(Yonsei University)
+ -3 AuthorsSomin Lee33
Estimated H-index: 33
(Yonsei University)
Fanny Guibert , Anne-Sophie Garnier2
Estimated H-index: 2
+ -3 AuthorsVirginie Besson3
Estimated H-index: 3
Background and objectives: The overlap between antineutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis (ANCA-GN) and connective tissue diseases (CTD) has been reported mainly as case series in the literature. Frequency of this association, as well as presentation and outcomes are unknown. Materials and Methods: Patients from the Maine-Anjou ANCA-associated vasculitides (AAV) registry with ANCA-GN diagnosed between 01/01/2000 and 01/01/2018, ANCA positivity, and at least six mont...
Published in Acta Oncologica3.30
Erik Hellbacher1
Estimated H-index: 1
(Uppsala University),
Karin Hjorton1
Estimated H-index: 1
(Uppsala University)
+ -3 AuthorsAnn Knight12
Estimated H-index: 12
(Uppsala University)
Masaki Mitsuhashi (YCU: Yokohama City University), Ryusuke Yoshimi11
Estimated H-index: 11
(YCU: Yokohama City University)
+ -3 AuthorsNobuhisa Mizuki33
Estimated H-index: 33
(YCU: Yokohama City University)
AbstractOptic perineuritis (OPN), which is an inflammatory disorder affecting the optic nerve sheath, is one of the rare complications in granulomatosis with polyangiitis (GPA). Although several gr...
Published in Rheumatology International2.20
Luis Corral-Gudino8
Estimated H-index: 8
,
Elvira González-Vázquez + -3 AuthorsJosé Luis Lerma-Márquez2
Estimated H-index: 2
The different sets of criteria for diagnosis or classification of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) lead to numerous overlapping and reclassified diagnoses in clinical practice. We designed this study to assess the difficulties in classifying patients with AAV. As a secondary objective, different variables were tested to predict prognosis. We conducted a retrospective chart review in a Western Spain multicentre survey. A total of 115 adult patients diagnosed with A...