Correspondence

Classification of Vasculitis

N Engl J Med 1999; 341:1774-1775December 2, 1999

Article

To the Editor:

Table 3 and Table 4 of Case 20-1999 (July 8 issue)1 are entitled “Criteria for the Diagnosis of Systemic Lupus Erythematosus” and “Criteria for the Diagnosis of Wegener's Granulomatosis,” respectively. However, both these lists from the American Rheumatism Association and the American College of Rheumatology are for classification, not for diagnostic purposes.2,3 It has been explicitly stated that these lists are “classification criteria . . . [and] are therefore not appropriate to use in the diagnosis of the individual patient.”4 It should also be noted that classification criteria established in 1990 by the American College of Rheumatology for various vasculitides, including Wegener's granulomatosis, apply only to patients who have a definite vasculitis.

The 1982 criteria for the classification of systemic lupus erythematosus were updated in 1997 by the Diagnostic and Therapeutic Criteria Committee of the American College of Rheumatology.5 Criterion 10(a), “positive LE [lupus erythematosus] cell preparation,” has been deleted. The initial formulation of criterion 10(d), restricted to false positive serologic tests for syphilis, has been extended to include an “abnormal serum level of IgG or IgM anticardiolipin antibodies” or a “positive test result for lupus anticoagulant using a standard method.”

Jean-Charles Piette, M.D.
Claire Fieschi, M.D.
Zahir Amoura, M.D.
Groupe Hospitalier Pitié–Salpêtrière, 75651 Paris CEDEX 13, France

5 References

1. 1

   Case Records of the Massachusetts General Hospital (Case 20-1999). N Engl J Med 1999;341:110-116
   Full Text | Web of Science | Medline

2. 2

   Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982;25:1271-1277
   CrossRef | Web of Science | Medline

3. 3

   Leavitt RY, Fauci AS, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis. Arthritis Rheum 1990;33:1101-1107
   CrossRef | Web of Science | Medline

4. 4

   Hunder GG, Arend WP, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis: introduction. Arthritis Rheum 1990;33:1065-1067
   CrossRef | Web of Science | Medline

5. 5

   Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997;40:1725-1725
   CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Schaller replies:

To the Editor: Piette et al. make an important point about disease criteria, and I must apologize for slothful proofreading. I assumed the tables were called classification criteria, not diagnostic criteria. There are no simple diagnostic criteria for any of the rheumatic diseases; the available criteria are only guidelines for thinking about the various diseases and for including patients in various series. Misuse of such classification criteria for the diagnosis of individual patients can lead to all kinds of errors. For example, any patient with rheumatoid arthritis who also happens to have had a recent streptococcal infection could be considered to have acute rheumatic fever if the Jones criteria were applied indiscriminately. Classification criteria are certainly valuable, but they are not diagnostic; we still have to think carefully about individual patients.

Jane G. Schaller, M.D.
Tufts University School of Medicine, Boston, MA 02111

Citing Articles (2)

Citing Articles

1. 1

   M. Kraemer, D. Linden, P. Berlit. (2005) The spectrum of differential diagnosis in neurological patients with livedo reticularis and livedo racemosa. Journal of Neurology 252:10, 1155-1166
   CrossRef

2. 2

   C Francès, J.C Piette. (2000) The Mystery of Sneddon Syndrome: Relationship with Antiphospholipid Syndrome and Systemic Lupus Erythematosus. Journal of Autoimmunity 15:2, 139-143
   CrossRef