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Is there a tool to help us differentiate vasculitis from its mimickers?
June 9 2016 10:41 PM ET — via RheumReports
Many of us have misdiagnosed patients with infection or malignancy as having vasculitis and vice versa. Wouldn't it be nice to have a tool to help us avoid making this mistake?
Raashid Luqmani from the UK presented data on Thursday at EULAR on the use of the Birmingham Vasculitis Activity Score (BVAS) to try to differentiate patients with vasculitis from their mimickers.
There is currently a joint group from EULAR and ACR working on new diagnostic and classification criteria in vasculitis (DCVAS), the results of which will be presented at the ACR in November 2016. As part of the DCVAS, the group is collecting data on patients with vasculitis in whom the treating physician is at least 75% certain of the diagnosis. This includes patients with GCA, TAK, PAN, and ANCA associated vasculitis (GPA, eGPA, MPA).
As part of this study, the investigators are also collecting matched data on comparator conditions which can mimic vasculitis (including malignancy, infection, etc). They analyzed 1122 patients with vasculitis and 487 comparators (vasculitis mimickers) and applied the BVAS score to determine if there was a difference between the two groups.
Interestingly, there was no difference in scores between patients with medium and large vessel vasculitis and their mimickers. However, in patients with ANCA associated vasculitis (AAV), there was a significant difference in BVAS scores between vasculitis patients and their mimickers (p<0.0001).
Furthermore, in each of the AAVs, there were different individual BVAS items that were specific for GPA, EGPA and MPA. Based on this data, the researchers have developed 'classification trees' to facilitate accurate and systematic screening of patients with suspected AAV based on clinical parameters alone.
Whilst the ANCA result contributed to the classification of MPA, it offered little additional value in distinguishing GPA or EGPA from their comparator conditions, limiting the value of ANCA testing for the purpose of screening for AAV.
Stay tuned for the entire publication, where we will hopefully be able to see the actual classification trees. Before we can use these confidently in clinical practice, they will have to be validated in another clinical population.
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About the Author
Dr. Shahin Jamal
Dr. Jamal is a Clinical Associate Professor at the University of British Columbia and an active staff physician at Vancouver Coastal Health. Her interests include diagnosis and prognosis of early inflammatory arthritis, and timely assessment and access to care for patients with rheumatoid arthritis.
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