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Nomenclature of systemic vasculitides. Proposal of an international consensus conference
J C Jennette1, R J Falk, K Andrassy
1Department of Pathology, School of Medicine, University of North Carolina, Chapel Hill 27599.
Insights
The Chapel Hill Consensus Conference updated nomenclature for systemic vasculitis, refining diagnostic criteria for conditions like polyarteritis nodosa and Wegener's granulomatosis. These changes improve classification for various vasculitis types.
Area of Science:
- Rheumatology
- Immunology
- Pathology
Background:
- The Chapel Hill Consensus Conference (CHCC) convened to establish standardized nomenclature for systemic vasculitis.
- Previous classifications lacked precision, leading to diagnostic challenges and inconsistent research findings.
Framework:
- The revised nomenclature restricts specific terms like "polyarteritis nodosa" to arteritis of medium and small arteries, excluding smaller vessels.
- Wegener's granulomatosis is now defined by granulomatous inflammation, differentiating it from microscopic polyangiitis.
- The term "hypersensitivity vasculitis" is discontinued, with cases reclassified under microscopic polyangiitis or cutaneous leukocytoclastic angiitis.
Implementation:
- Microscopic polyangiitis (or microscopic polyarteritis) is characterized by pauci-immune necrotizing vasculitis of small vessels.
- Cutaneous leukocytoclastic angiitis is specifically defined as vasculitis limited to the skin.
- Patient age is noted as a discriminator for Takayasu arteritis versus giant cell (temporal) arteritis.
Implications:
- These updated definitions provide a clearer framework for diagnosing and classifying systemic vasculitis.
- Standardized terminology facilitates better communication among clinicians and researchers.
- Improved classification aids in understanding disease pathogenesis and developing targeted therapies for vasculitis.
Abstract:
The following are some of the conclusions and proposals made at the Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis. 1. Although not a prerequisite component of the definitions, patient age is recognized as a useful discriminator between Takayasu arteritis and giant cell (temporal) arteritis. 2. The name "polyarteritis nodosa," or alternatively, the name "classic polyarteritis nodosa," is restricted to disease in which there is arteritis in medium-sized and small arteries without involvement of smaller vessels. Therefore, patients with vasculitis affecting arterioles, venules, or capillaries, including glomerular capillaries (i.e., with glomerulonephritis), are excluded from this diagnostic category. 3. The name "Wegener's granulomatosis" is restricted to patients with granulomatous inflammation. Patients with exclusively nongranulomatous small vessel vasculitis involving the upper or lower respiratory tract (e.g., alveolar capillaritis) fall into the category of microscopic polyangiitis (microscopic polyarteritis). 4. The term "hypersensitivity vasculitis" is not used. Most patients who would have been given this diagnosis fall into the category of microscopic polyangiitis (microscopic polyarteritis) or cutaneous leukocytoclastic angiitis. 5. The name "microscopic polyangiitis," or alternatively, "microscopic polyarteritis," connotes pauci-immune (i.e., few or no immune deposits) necrotizing vasculitis affecting small vessels, with or without involvement of medium-sized arteries. Cryoglobulinemic vasculitis, Henoch-Schönlein purpura, and other forms of immune complex-mediated small vessel vasculitis must be ruled out to make this diagnosis. 6. The name "cutaneous leukocytoclastic angiitis" is restricted to vasculitis in the skin without involvement of vessels in any other organ. 7. Mucocutaneous lymph node syndrome must be present to make a diagnosis of Kawasaki disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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