Vasculitis: do we know more to classify better?

Abstract

The systemic vasculitides are a heterogeneous group of disorders characterized by the inflammation of blood vessels. The development and implementation of advanced diagnostic tests and genetic studies have resulted in substantial improvement in our understanding of vasculitis pathogenesis, resulting in the revision of the nomenclature and classification for vasculitis. Multicenter, collaborative studies are currently underway to develop improved diagnostic criteria. In this review, the major nomenclature and classification systems for vasculitides are summarized, with special emphasis on those emerging from the recent 2012 Chapel Hill Consensus Conference (CHCC).

Ultrasound, X‑ray, computed tomography and clinical tests for diagnosis of abdominal purpura in children: A retrospective study

“…Abdominal gastrointestinal symptoms are often observed prior to clinical symptoms (4). Ultrasound, CT and X-ray provide direct insight into visualization and detection of complications and bowel involvement (for example, bowel perforation and intussusception) (13) but imaging criteria are not used in the diagnosis of purpura (9). Even The European League Against Rheumatism, The Pediatric Rheumatology International Trials Organization and The Pediatric Rheumatology European Society 2010 criteria (15), which are the current gold standard, do not include imaging criteria for the diagnosis of abdominal purpura (4).…”

“…Furthermore, endoscopic examinations can be more useful in view of the pathophysiology of the disease, but endoscopy was not performed at all. Additionally, serum immunoglobulin A was not used to detect abdominal purpura in the children (9). The justification for that the level of serum immunoglobulin A is varied with age and the other demographical and clinical characters.…”

“…Moreover, biopsies are often difficult to obtain and some patients can have atypical presentations. In addition, the age criteria are considered to be redundant (9). Lastly, imaging modalities are not used routinely in the evaluation of abdominal purpura (10).…”

Diagnostic approach and current treatment options in childhood vasculitis

“…The classification criteria have been developed in order to arrange the clinical definitions of different vasculitides in the most comrehensible way, but not to make the diagnosis (2,3). Initially, the "American College of Rheumatology" (ACR) criteria were developed in 1990 mainly for adulthood vasculitides and also included the criteria used for childhood vasculitides.…”