The 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria for IgG4‐Related Disease

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Abstract

IgG4-related disease (IgG4-RD) can cause fibroinflammatory lesions in nearly any organ. Correlation among clinical, serologic, radiologic, and pathologic data is required for diagnosis. This work was undertaken to develop and validate an international set of classification criteria for IgG4-RD.

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Most cited references 30

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Index for rating diagnostic tests

W. J. Youden, Michele Teng, Matthew Taliaferro … (1951)

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2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.

Daniel Aletaha, Tuhina Neogi, Alan J Silman … (2010)

The 1987 American College of Rheumatology (ACR; formerly, the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticized for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA. A joint working group from the ACR and the European League Against Rheumatism developed, in 3 phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease--this being the appropriate current paradigm underlying the disease construct "rheumatoid arthritis." In the new criteria set, classification as "definite RA" is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in 4 domains: number and site of involved joints (score range 0-5), serologic abnormality (score range 0-3), elevated acute-phase response (score range 0-1), and symptom duration (2 levels; range 0-1). This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late-stage features. This will refocus attention on the important need for earlier diagnosis and institution of effective disease-suppressing therapy to prevent or minimize the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct "rheumatoid arthritis."

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2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative.

Frank J.A. van den Hoogen, Dinesh Khanna, Jaap Fransen … (2013)

The 1980 American College of Rheumatology (ACR) classification criteria for systemic sclerosis (SSc) lack sensitivity for early SSc and limited cutaneous SSc. The present work, by a joint committee of the ACR and the European League Against Rheumatism (EULAR), was undertaken for the purpose of developing new classification criteria for SSc. Using consensus methods, 23 candidate items were arranged in a multicriteria additive point system with a threshold to classify cases as SSc. The classification system was reduced by clustering items and simplifying weights. The system was tested by 1) determining specificity and sensitivity in SSc cases and controls with scleroderma-like disorders, and 2) validating against the combined view of a group of experts on a set of cases with or without SSc. It was determined that skin thickening of the fingers extending proximal to the metacarpophalangeal joints is sufficient for the patient to be classified as having SSc; if that is not present, 7 additive items apply, with varying weights for each: skin thickening of the fingers, fingertip lesions, telangiectasia, abnormal nailfold capillaries, interstitial lung disease or pulmonary arterial hypertension, Raynaud's phenomenon, and SSc-related autoantibodies. Sensitivity and specificity in the validation sample were, respectively, 0.91 and 0.92 for the new classification criteria and 0.75 and 0.72 for the 1980 ACR classification criteria. All selected cases were classified in accordance with consensus-based expert opinion. All cases classified as SSc according to the 1980 ACR criteria were classified as SSc with the new criteria, and several additional cases were now considered to be SSc. The ACR/EULAR classification criteria for SSc performed better than the 1980 ACR criteria for SSc and should allow for more patients to be classified correctly as having the disease. Copyright © 2013 by the American College of Rheumatology.

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Author and article information

Journal

Title: Arthritis & Rheumatology

Abbreviated Title: Arthritis Rheumatol

Publisher: Wiley

ISSN (Print): 2326-5191

ISSN (Electronic): 2326-5205

Publication date Created: December 02 2019

Publication date (Electronic): December 02 2019

Affiliations

[1 ]Massachusetts General Hospital Boston

[2 ]New Zealand Health Ministry Auckland New Zealand

[3 ]Mayo Clinic Rochester Minnesota

[4 ]IRCCS Ospedale San Raffaele Milan Italy

[5 ]Pinnacle, Inc. Montreal Quebec Canada

[6 ]Ohio State University College of Medicine Columbus

[7 ]Kanazawa University Kanazawa Japan

[8 ]Kanazawa University Hospital Kanazawa Japan

[9 ]Emory University Atlanta Georgia

[10 ]Yokohama City University Yokohama Japan

[11 ]IRCCS Milan Italy

[12 ]Kansai Medical University Hirakata Japan

[13 ]Nagaoka Red Cross Hospital Nagaoka Japan

[14 ]Aix‐Marseille University Marseille France

[15 ]Kanazawa Medical University, Uchinada, Japan, and Hayashi Hospital Echizen Japan

[16 ]University College London London UK

[17 ]Kobe University Kobe Japan

Article

DOI: 10.1002/art.41120

PubMed ID: 31793250

SO-VID: 2acda300-c288-4e2d-8134-141e935b609b

License:

http://onlinelibrary.wiley.com/termsAndConditions#vor

http://doi.wiley.com/10.1002/tdm_license_1.1

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