A paradigm of diagnostic criteria for polyarteritis nodosa: analysis of a series of 949 vasculitides

Abstract : Objective: To establish a set of clinical and paraclinical criteria potentially useful as a diagnostic screening tool for polyarteritis nodosa (PAN). Methods: The abilities of individual descriptive items to predict PAN diagnosis were evaluated by screening available data for 949 patients entered in the French Vasculitis Study Group's (FVSG) database, including 262 with PAN and 687 control vasculitides. Selected items were tested in a logistic-regression model to establish a minimal set of non-redundant PAN predictive criteria. The discriminative accuracy of these items and of 1990 ACR criteria were assessed by reapplying them to the initial patient sample and a subgroup restricted to PAN and microscopic polyangiitis (MPA) patients. A computer-simulation procedure was conducted on artificially generated patient data to evaluate the usefulness of these criteria to predict PAN diagnosis. Results: The analysis retained 3 positive-predictive (HBV-antigen and/or DNA in serum, arteriographic anomalies, mono- or polyneuropathy) and 5 negative-predictive parameters (indirect immunofluorescence ANCA detection, asthma, ENT signs, glomerulopathy, and cryoglobulinemia), yielding 70.6% sensitivity for all control vasculitides and 89.7% for MPA controls, with 92.3% specificity for all controls and 83.1% for MPA. The discriminant abilities of this set of items outperformed the 1990 ACR criteria in all analytical situations, showing better robustness to variations in the prevalence of individual vasculitides. Conclusion: The use of positive and negative discriminant criteria could constitute a sound basis for developing a PAN diagnostic tool for clinicians. Further prospective analyses and validations in different populations are needed to confirm these items as satisfactory diagnostic criteria.
Type de document :
Article dans une revue
Arthritis and Rheumatism, Wiley, 2008, 58 (5), pp.1528-1538
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https://hal.archives-ouvertes.fr/hal-00267634
Contributeur : Avner Bar-Hen <>
Soumis le : jeudi 27 mars 2008 - 20:49:33
Dernière modification le : lundi 29 mai 2017 - 15:33:42

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  • HAL Id : hal-00267634, version 1

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Corneliu Henegar, Christian Pagnoux, Xavier Puechal, Jean-Daniel Zucker, Avner Bar-Hen, et al.. A paradigm of diagnostic criteria for polyarteritis nodosa: analysis of a series of 949 vasculitides. Arthritis and Rheumatism, Wiley, 2008, 58 (5), pp.1528-1538. <hal-00267634>

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