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Diagnosis and/or classification of vasculitis: different?
1aAcademic Hospital, Uskudar, Istanbul, Turkey bNYU Hospital for Joint Diseases, New York, USA.
Current Opinion in Rheumatology
|November 12, 2015
Summary
Developing separate diagnostic and classification criteria for vasculitides is unrealistic. Probabilistic reasoning is crucial for accurate diagnosis and patient care, yet often overlooked in current research.
Area of Science:
- Rheumatology
- Clinical Immunology
Background:
- Current diagnostic criteria for vasculitides are lacking.
- Initiatives by the European League Against Rheumatism and American College of Rheumatology aim to establish separate classification and diagnostic criteria.
- This review re-evaluates previous disagreements regarding separate criteria in light of new evidence.
Purpose of the Study:
- To critically assess the feasibility and utility of developing separate diagnostic and classification criteria for vasculitides.
- To highlight the inadequate incorporation of probabilistic methods in existing criteria development.
Main Methods:
- Review of existing literature on diagnostic and classification criteria for vasculitides.
- Analysis of methodologies used in criteria development, focusing on the application of probability theory.
Main Results:
- No clear methodologies for separate diagnostic and classification criteria have been proposed.
- Probabilistic concepts like Bayes' theorem, predictive values, and confidence intervals are underutilized (less than 4% of reviewed articles).
- Persistent misconceptions regarding circularity and the role of nomenclature in criteria development were observed.
Conclusions:
- Separate diagnostic and classification criteria for vasculitides are deemed unrealistic and impractical.
- Classification criteria and nomenclature serve as tools for diagnosis, not distinct entities for patient care or research.
- Emphasizing a transparent discussion of diagnostic probabilities is essential for patients and all stakeholders.
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