0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Limitations of the 1990 American College of Rheumatology Classification Criteria in the Diagnosis of Vasculitis

Jaya K. Rao, MD, MHS; Nancy B. Allen, MD; and Theodore Pincus, MD
[+] Article and Author Information

From Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana; Duke University Medical Center, Durham, North Carolina; and Vanderbilt University School of Medicine, Nashville, Tennessee. For current author addresses, see end of text. Acknowledgments: The authors thank Morris Weinberger, PhD, and Thomas F. Imperiale, MD, for their constructive reviews of earlier versions of this manuscript. Grant Support: In part by the Durham Veterans Affairs Health Services Research Field Program and the Department of Veterans Affairs Fellowship Program in Health Services Research (Dr. Rao). Dr. Rao is currently supported by the Department of Veterans Affairs Health Services Research Career Development Program. Requests for Reprints: Jaya K. Rao, MD, MHS, Center for Health Services Research (11H), Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, Indianapolis, IN 46202. Current Author Addresses: Dr. Rao: Center for Health Services Research (11H), Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, Indianapolis, IN 46202.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(5):345-352. doi:10.7326/0003-4819-129-5-199809010-00001
Text Size: A A A

Background: The American College of Rheumatology (ACR) established criteria to discriminate among patients with seven types of vasculitis. Although designated as “classification criteria” for research, these criteria are often used for diagnosis.

Objective: To examine the operating characteristics of the 1990 ACR classification criteria in the diagnosis of Wegener granulomatosis, giant-cell arteritis, polyarteritis nodosa, and hypersensitivity vasculitis.

Design: Prospective cohort study.

Setting: University medical center and Veterans Affairs medical center.

Patients: 198 consecutive patients referred to rheumatologists for evaluation of possible vasculitis.

Measurements: Blinded chart audits were done to classify patients according to the 1990 ACR classification criteria for Wegener granulomatosis, polyarteritis nodosa, giant-cell arteritis, and hypersensitivity vasculitis on the basis of the patients' initial presentation. Chart audits done 2 to 8 months after baseline provided the patients' final diagnoses, which were considered the gold standard, as in the development of the ACR criteria. Test operating characteristics of the ACR classification criteria were calculated according to 2 × 2 tables for the entire cohort and for only the patients with a final diagnosis of vasculitis.

Results: Vasculitis was diagnosed in 51 (26%) patients. Thirty-eight (75%) of 51 patients with vasculitis and 31 (21%) of 147 patients without vasculitis met ACR criteria for one or more types of vasculitis. The positive predictive values for the four vasculitides according to ACR criteria were 17% to 29% for the entire cohort and 29% to 75% for only the patients with a final diagnosis of vasculitis.

Conclusion: The 1990 ACR classification criteria function poorly in the diagnosis of specific vasculitides.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)