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Provisional seven-item criteria for the diagnosis of polyarteritis nodosa

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Abstract

Polyarteritis nodosa (PAN) is a potentially life-threatening systemic vasculitis, which predominantly involves medium arteries. However, it may be difficult to diagnose PAN in its early stage. The aim of our study was to investigate the sensitivity and specificity of the American College of Rheumatology (ACR) and the Japanese Ministry of Health, Labour and Welfare (MHLW) criteria for the diagnosis of PAN in a single-centre retrospective cohort in Japan and to develop simplified criteria with favourable diagnostic performance. All patients with “PAN” or “suspicion of PAN,” as indicated on insurance forms, were included. The patient population was classified into PAN and non-PAN groups based on a retrospective chart review. The sensitivity and specificity of the ACR and MHLW criteria were calculated. Items that favourably discriminated the PAN group from the non-PAN group were determined and used as items for our provisional criteria. Thirteen cases of PAN and 24 cases without PAN were included in this study. The sensitivities of the ACR and MHLW criteria were 61.5% (8/13) and 30.8% (4/13), respectively, whereas the specificities were 79.2% (19/24) and 87.5% (21/24), respectively. We developed provisional criteria consisting of seven items, and found that a cut-off of ≥ 4 items had a sensitivity of 92.3% (12/13) and specificity of 91.7% (22/24) (p < 0.000001). The provisional seven-item criteria, developed in our real-world cohort of patients suspected of having PAN, had a high sensitivity and specificity and may be useful in the diagnosis of PAN, although it should be validated in additional patient populations.

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References

  1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F et al (2013) 2012 Revised International Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 65:1–11. https://doi.org/10.1002/art.37715

    Article  CAS  PubMed  Google Scholar 

  2. Levine SM, Hellmann DB, Stone JH (2002) Gastrointestinal involvement in polyarteritis nodosa (1986–2000): presentation and outcomes in 24 patients. Am J Med 112:386–391. https://doi.org/10.1016/S0002-9343(01)01131-7

    Article  PubMed  Google Scholar 

  3. Bloch DA, Michel BA, Hunder GG, McShane DJ, Arend WP, Calabrese LH et al (1990) The American College of Rheumatology 1990 criteria for the classification of vasculitis. Patients and methods. Arthritis Rheum 33:1068–1073. https://doi.org/10.1002/art.1780330805

    Article  CAS  PubMed  Google Scholar 

  4. Lightfoot RW Jr, Michel BA, Bloch DA, Hunder GG, Zvaifler NJ, McShane DJ et al (1990) The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 33:1088–1093. https://doi.org/10.1002/art.1780330805

    Article  PubMed  Google Scholar 

  5. Rao JK, Allen NB, Pincus T (1998) Limitations of the 1990 American College of Rheumatology classification criteria in the diagnosis of vasculitis. Ann Int Med 129:345–352. https://doi.org/10.7326/0003-4819-129-5-199809010-00001

    Article  CAS  PubMed  Google Scholar 

  6. Seeliger B, Sznajd J, Robson JC, Judge A, Craven A, Grayson PC et al (2017) Are the 1990 American College of Rheumatology vasculitis classification criteria still valid? Rheumatology 56:1154–1161. https://doi.org/10.1093/rheumatology/kex075

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. JCS Joint Working Group (2011) Guideline for management of vasculitis syndrome (JCS 2008) Japanese Circulation Society. Circ J 75:474–503. https://doi.org/10.1253/circj.CJ-88-0007

    Article  Google Scholar 

  8. Watts R, Lane S, Hanslik T, Hauser T, Hellmich B, Koldingsnes W et al (2007) Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 66:222–227. https://doi.org/10.1136/ard.2006.054593

    Article  PubMed  Google Scholar 

  9. Froud R, Abel G (2014) Using ROC curves to choose minimally important change thresholds when sensitivity and specificity are valued equally: the forgotten lesson of Pythagoras. Theoretical considerations and an example application of change in health status. PLoS ONE 9:e114468. https://doi.org/10.1371/journal.pone.0120967

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Kanda Y (2013) Investigation of the freely available easy-to-use software ’EZR’ for medical statistics. Bone Marrow Transplant 48:452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  PubMed  Google Scholar 

  11. Basu N, Watts R, Bajema I, Baslund B, Bley T, Boers M et al (2010) EULAR points to consider in the development of classification and diagnostic criteria in systemic vasculitis. Ann Rheum Dis 69:1744–1750. https://doi.org/10.1136/ard.2009.119032

    Article  PubMed  Google Scholar 

  12. Kaneko Y, Kuwana M, Kameda H, Takeuchi T (2011) Sensitivity and specificity of 2010 rheumatoid arthritis classification criteria. Rheumatology (Oxford) 50:1268–1274. https://doi.org/10.1093/rheumatology/keq442

    Article  Google Scholar 

  13. Ighe A, Dahlström Ö, Skogh T, Sjöwall C (2015) Application of the 2012 Systemic Lupus International Collaborating Clinics classification criteria to patients in a regional Swedish systemic lupus erythematosus register. Arthritis Res Ther 17:3. https://doi.org/10.1186/s13075-015-0521-9

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors thank the distinguished rheumatologists at our hospital, Yohei Hosokawa, Kei Araki, Masanori Kawashima, and Yuji Yamanishi for their assessment of the cases in this study. We also thank Yoichiro Toi, Shoichiro Kojo, Takashi Kihara, Yasushi Yamasaki, Koichi Ichimura, Nobuyuki Yajima, Akira Kuriyama and Ryoichi Okamoto for their help with this study. We would like to thank FORTE (https://www.forte-science.co.jp/) for the English language editing.

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  1. Shintaro Yamamoto

    Present address: Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan

Authors and Affiliations

  1. Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima City, Hiroshima, 730-8518, Japan

    Shintaro Yamamoto & Hiroshi Oiwa

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  1. Shintaro Yamamoto
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  2. Hiroshi Oiwa
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Contributions

Both the authors met the four criteria that ICMJE recommended: (1) substantial contributions to the conception or deign of the work; or the acquisition, analysis, or interpretation of data for the work AND (2) drafting the work or revising it critically for important intellectual content AND (3) final approval of the version to be published AND (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. We declare both the authors take full responsibility for all aspects of the study and the final manuscript.

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Correspondence to Hiroshi Oiwa.

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The authors have no conflicts of interest to declare.

Ethical standards

This study complied with the Declaration of Helsinki, and the institutional review boards of the Hiroshima City Hiroshima Citizens Hospital approved this study (approval number: 2019–157). The need to obtain informed consent from the patients was waived in accordance with the regulations for retrospective cohort studies. Information for patients regarding this study was provided on our hospital’s website.

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Yamamoto, S., Oiwa, H. Provisional seven-item criteria for the diagnosis of polyarteritis nodosa. Rheumatol Int 40, 1223–1227 (2020). https://doi.org/10.1007/s00296-020-04535-2

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