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

Neil Basu, Richard Watts, Ingeborg Bajema, Bo Baslund, Thorsten Bley, Maarten Boers, Paul Brogan, Len Calabrese, Maria C. Cid, Jan Willem Cohen-Tervaert, Luis Felipe Flores-Suarez, Shouichi Fujimoto, Kirsten de Groot, Loic Guillevin, Gulen Hatemi, Thomas Hauser, David Jayne, Charles Jennette, Cees G. M. Kallenberg, Shigeto Kobayashi & 19 others Mark A Little, Alfred Mahr, John McLaren, Peter A. Merkel, Seza Ozen, Xavier Puechal, Niels Rasmussen, Alan Salama, Carlo Salvarani, Caroline Savage, David G. I. Scott, Mårten Segelmark, Ulrich Specks, Cord Sunderköetter, Kazuo Suzuki, Vladimir Tesar, Allan Wiik, Hasan Yazici, Raashid Luqmani

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

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 However, key aspects of current nomenclature are widely perceived to be out of date, these include disease definitions, classification and diagnostic criteria.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.
Original languageEnglish
Pages (from-to)1744-1750
Number of pages7
JournalAnnals of the Rheumatic Diseases
Volume69
Issue number10
Early online date6 May 2010
DOIs
Publication statusPublished - Oct 2010

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Systemic Vasculitis
Biopsy
Terminology
Vasculitis
Rheumatic Diseases
Radiology
Magnetic resonance imaging
Early Diagnosis
Cytoplasm
Neutrophils
Biomarkers
Ultrasonics
Antibodies
Testing
Research

Keywords

  • biological markers
  • biopsy
  • Delphi technique
  • evidence-based medicine
  • humans
  • systemic vasculitis
  • terminology as topic

Cite this

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

In: Annals of the Rheumatic Diseases, Vol. 69, No. 10, 10.2010, p. 1744-1750.

Research output: Contribution to journalArticle

Basu, N, Watts, R, Bajema, I, Baslund, B, Bley, T, Boers, M, Brogan, P, Calabrese, L, Cid, MC, Cohen-Tervaert, JW, Flores-Suarez, LF, Fujimoto, S, de Groot, K, Guillevin, L, Hatemi, G, Hauser, T, Jayne, D, Jennette, C, Kallenberg, CGM, Kobayashi, S, Little, MA, Mahr, A, McLaren, J, Merkel, PA, Ozen, S, Puechal, X, Rasmussen, N, Salama, A, Salvarani, C, Savage, C, Scott, DGI, Segelmark, M, Specks, U, Sunderköetter, C, Suzuki, K, Tesar, V, Wiik, A, Yazici, H & Luqmani, R 2010, 'EULAR points to consider in the development of classification and diagnostic criteria in systemic vasculitis', Annals of the Rheumatic Diseases, vol. 69, no. 10, pp. 1744-1750. https://doi.org/10.1136/ard.2009.119032
Basu, Neil ; Watts, Richard ; Bajema, Ingeborg ; Baslund, Bo ; Bley, Thorsten ; Boers, Maarten ; Brogan, Paul ; Calabrese, Len ; Cid, Maria C. ; Cohen-Tervaert, Jan Willem ; Flores-Suarez, Luis Felipe ; Fujimoto, Shouichi ; de Groot, Kirsten ; Guillevin, Loic ; Hatemi, Gulen ; Hauser, Thomas ; Jayne, David ; Jennette, Charles ; Kallenberg, Cees G. M. ; Kobayashi, Shigeto ; Little, Mark A ; Mahr, Alfred ; McLaren, John ; Merkel, Peter A. ; Ozen, Seza ; Puechal, Xavier ; Rasmussen, Niels ; Salama, Alan ; Salvarani, Carlo ; Savage, Caroline ; Scott, David G. I. ; Segelmark, Mårten ; Specks, Ulrich ; Sunderköetter, Cord ; Suzuki, Kazuo ; Tesar, Vladimir ; Wiik, Allan ; Yazici, Hasan ; Luqmani, Raashid. / EULAR points to consider in the development of classification and diagnostic criteria in systemic vasculitis. In: Annals of the Rheumatic Diseases. 2010 ; Vol. 69, No. 10. pp. 1744-1750.
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abstract = "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.",
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T1 - EULAR points to consider in the development of classification and diagnostic criteria in systemic vasculitis

AU - Basu, Neil

AU - Watts, Richard

AU - Bajema, Ingeborg

AU - Baslund, Bo

AU - Bley, Thorsten

AU - Boers, Maarten

AU - Brogan, Paul

AU - Calabrese, Len

AU - Cid, Maria C.

AU - Cohen-Tervaert, Jan Willem

AU - Flores-Suarez, Luis Felipe

AU - Fujimoto, Shouichi

AU - de Groot, Kirsten

AU - Guillevin, Loic

AU - Hatemi, Gulen

AU - Hauser, Thomas

AU - Jayne, David

AU - Jennette, Charles

AU - Kallenberg, Cees G. M.

AU - Kobayashi, Shigeto

AU - Little, Mark A

AU - Mahr, Alfred

AU - McLaren, John

AU - Merkel, Peter A.

AU - Ozen, Seza

AU - Puechal, Xavier

AU - Rasmussen, Niels

AU - Salama, Alan

AU - Salvarani, Carlo

AU - Savage, Caroline

AU - Scott, David G. I.

AU - Segelmark, Mårten

AU - Specks, Ulrich

AU - Sunderköetter, Cord

AU - Suzuki, Kazuo

AU - Tesar, Vladimir

AU - Wiik, Allan

AU - Yazici, Hasan

AU - Luqmani, Raashid

PY - 2010/10

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N2 - 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.

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KW - biological markers

KW - biopsy

KW - Delphi technique

KW - evidence-based medicine

KW - humans

KW - systemic vasculitis

KW - terminology as topic

U2 - 10.1136/ard.2009.119032

DO - 10.1136/ard.2009.119032

M3 - Article

VL - 69

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JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

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ER -