Journal Article

EULAR points to consider in the development of classification and diagnostic criteria in systemic vasculitis

McLaren, John, Tesar, Vladimir, Suzuki, Kazuo, Cid, Maria C, Little, Mark A, Mahr, Alfred, Jayne, David, Ozen, Seza, Yazici, Hasan, Guillevin, Loic, Boers, Maarten, Brogan, Paul, Flores-Suarez, Luis Felipe, Calabrese, Len, Merkel, Peter A, Basu, Neil, Scott, David G I, Hauser, Thomas, Salama, Alan, Wiik, Allan, Baslund, Bo, Watts, Richard, Fujimoto, Shouichi, Jennette, Charles, Hatemi, Gulen, Luqmani, Raashid, Bajema, Ingeborg, Kallenberg, Cees G M, Savage, Caroline, Specks, Ulrich, Puechal, Xavier, de Groot, Kirsten, Bley, Thorsten, Rasmussen, Niels, Cohen-Tervaert, Jan Willem, Segelmark, Mårten, Kobayashi, Shigeto, Sunderköetter, Cord, Salvarani, Carlo

2010

Overview

Objectives The systemic vasculitides are multiorgan diseases where early diagnosis and treatment can significantly improve outcomes. Robust nomenclature reduces diagnostic delay. However, key aspects of current nomenclature are widely perceived to be out of date, these include disease definitions, classification and diagnostic criteria. Therefore, the aim of the present work was to identify deficiencies and provide contemporary points to consider for the development of future definitions and criteria in systemic vasculitis. Methods The expert panel identified areas of concern within existing definitions/criteria. Consequently, a systematic literature review was undertaken looking to address these deficiencies and produce ‘points to consider’ in accordance with standardised European League Against Rheumatism (EULAR) operating procedures. In the absence of evidence, expert consensus was used. Results There was unanimous consensus for re-evaluating existing definitions and developing new criteria. A total of 17 points to consider were proposed, covering 6 main areas: biopsy, laboratory testing, diagnostic radiology, nosology, definitions and research agenda. Suggestions to improve and expand current definitions were described including the incorporation of anti-neutrophil cytoplasm antibody and aetiological factors, where known. The importance of biopsy in diagnosis and exclusion of mimics was highlighted, while equally emphasising its problems. Thus, the role of alternative diagnostic tools such as MRI, ultrasound and surrogate markers were also discussed. Finally, structures to develop future criteria were considered. Conclusions Limitations in current classification criteria and definitions for vasculitis have been identified and suggestions provided for improvement. Additionally it is proposed that, in combination with the updated evidence, these should form the basis of future attempts to develop and validate revised criteria and definitions of vasculitis.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,BMJ Publishing Group,Elsevier Limited
• Subject: Biological and medical sciences / Biomarkers - analysis / Biopsy / Classification / Clinical Medicine / Delphi Technique / Diseases of the osteoarticular system / Epidemiology / Evidence-Based Medicine - methods / Humans / Klinisk medicin / Literature reviews / Medical and Health Sciences / Medical sciences / Medical Subject Headings-MeSH / Medicin och hälsovetenskap / Purpura / Rheumatology / Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis / Systemic Vasculitis - classification / Systemic Vasculitis - diagnosis / Terminology as Topic / Vein & artery diseases