The American college of rheumatology 1990 criteria for the classification of polyarteritis nodosa

Authors

  • Robert W. Lightfoot Jr Md,

    Corresponding author
    1. University of Kentucky, Lexington, KY
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • Beat A. Michel MD,

    Corresponding author
    1. Rheumaklinik Universitätsspital, Zurich, Switzerland
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • Daniel A. Bloch PhD,

    Corresponding author
    1. Stanford University, Stanford, CA
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • Gene G. Hunder MD,

    Corresponding author
    1. Mayo Clinic, Rochester, MN, and Chair, Subcommittee on Classification of Vasculitis
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • Nathan J. Zvaifler MD,

    Corresponding author
    1. University of California, San Diego, San Diego, CA
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • Dennis J. McShane MD,

    Corresponding author
    1. Stanford University, Stanford, CA
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • William P. Arend MD,

    Corresponding author
    1. University of Colorado Health Science Center, Denver, CO
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • Leonard H. Calabrese DO,

    Corresponding author
    1. Cleveland Clinic Foundation, Cleveland, OH
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • Randi Y. Leavitt MD, Phd,

    Corresponding author
    1. NIAID, NIH, Bethesda, MD
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • J. T. Lie MD,

    Corresponding author
    1. Mayo Clinic, Rochester, MN
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • Alfonse T. Masi MD, DRPH,

    Corresponding author
    1. University of Illinois College of Medicine, Peoria, IL
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • John A. Mills MD,

    Corresponding author
    1. Massachusetts General Hospital, Boston, MA
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • Mary Betty Stevens MD,

    Corresponding author
    1. Johns Hopkins University, Baltimore, MD
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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  • Stanley L. Wallace MD

    Corresponding author
    1. SUNY Downstate Medical Center, Brooklyn, NY
    • American College of Rheumatology, 17 Executive Park Drive NE, Atlanta, GA 30329
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Abstract

Criteria for the classification of polyarteritis nodosa were developed by comparing 118 patients who had this disease with 689 control patients who had other forms of vasculitis. For the traditional format classification, 10 criteria were selected: weight loss ≥4 kg, livedo reticularis, testicular pain or tenderness, myalgias, mononeuropathy or polyneuropathy, diastolic blood pressure >90 mm Hg, elevated blood urea nitrogen or serum creatinine levels, presence of hepatitis B reactants in serum, arteriographic abnormality, and presence of granulocyte or mixed leukocyte infiltrate in an arterial wall on biopsy. The presence of 3 or more of these 10 criteria was associated with a sensitivity of 82.2% and specificity of 86.6%. A classification tree was also constructed, with 6 criteria being selected. Three of these, angiographic abnormality, biopsy-proven granulocyte or mixed leukocyte infiltrate in arterial wall, and neuropathy, were criteria used in the traditional format. The other 3 criteria used in the tree format included the patient's sex, weight loss >6.5 kg, and elevated serum aspartate aminotransferase or alanine aminotransferase levels above the range of normal. The classification tree yielded a sensitivity of 87.3% and a specificity of 89.3%.

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