title: A paradigm of diagnostic criteria for polyarteritis nodosa: analysis of a series of 949 patients with vasculitides.
abstract: OBJECTIVE
  To establish a set of clinical and paraclinical criteria potentially useful as a diagnostic screening tool for polyarteritis nodosa (PAN).
  
  
  METHODS
  The abilities of individual descriptive items to predict a diagnosis of PAN were evaluated by screening available data from 949 patients from the French Vasculitis Study Group database, including 262 with PAN and 687 with control vasculitides. Selected items were tested in a logistic regression model to establish a minimal set of nonredundant PAN-predictive criteria. The discriminative accuracy of these items and of the American College of Rheumatology (ACR) 1990 criteria were assessed by reapplying them to the initial patient sample and a subgroup restricted to PAN and microscopic polyangiitis (MPA) patients. A computer simulation procedure was conducted on artificially generated patient data to evaluate the usefulness of these criteria in predicting a diagnosis of PAN.
  
  
  RESULTS
  The analysis resulted in the retention of 3 positive predictive parameters (hepatitis B virus antigen and/or DNA in serum, arteriographic anomalies, and mononeuropathy or polyneuropathy) and 5 negative predictive parameters (indirect immunofluorescence detection of antineutrophil cytoplasmic antibody; asthma; ear, nose, and throat signs; glomerulopathy; and cryoglobulinemia) for the criteria set. These criteria yielded 70.6% sensitivity for all control vasculitides and 89.7% for MPA controls, with 92.3% specificity for all controls and 83.1% for MPA controls. The discriminant abilities of this set of items outperformed the ACR 1990 criteria in all analytical situations, showing better robustness to variations in the prevalence of individual vasculitides.
  
  
  CONCLUSIONS
  The use of positive and negative discriminant criteria could constitute a sound basis for developing a diagnostic tool for PAN to be used by clinicians. Further prospective analyses and validations in different populations are needed to confirm these items as satisfactory diagnostic criteria.
authors.affiliation: Hôpital Cochin, Paris 5-René Descartes University, Assistance Publique Hôpitaux de Paris, France.
authors.forename: Corneliu
authors.initials: C
authors.lastname: Henegar
authors.forename: Christian
authors.initials: C
authors.lastname: Pagnoux
authors.forename: Xavier
authors.initials: X
authors.lastname: Puéchal
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Zucker
authors.forename: Avner
authors.initials: A
authors.lastname: Bar-Hen
authors.forename: Véronique
authors.initials: V
authors.lastname: Le Guern
authors.forename: Mona
authors.initials: M
authors.lastname: Saba
authors.forename: Denis
authors.initials: D
authors.lastname: Bagnères
authors.forename: Olivier
authors.initials: O
authors.lastname: Meyer
authors.forename: Loïc
authors.initials: L
authors.lastname: Guillevin
mesh_terms: D003937:Diagnosis, Differential; D005240:Feasibility Studies; D006801:Humans; D010488:Polyarteritis Nodosa / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D014657:Vasculitis / Q000175:diagnosis