Research
Are classification criteria for vasculitis useful in clinical practice? Observations and lessons from Colombia
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* Corresponding author: Eric L Matteson matteson.eric@mayo.edu
1 Rheumatology Fellow, Department of Internal Medicine, Rheumatology Unit, Universidad Nacional de Colombia, Bogota, Columbia
2 Professor of Medicine, Department of Internal Medicine, Rheumatology Unit, Chief of Rheumatology Unit, Universidad Nacional de Colombia, Bogota, Columbia
3 Assistant Professor, Department of Internal Medicine, Rheumatology Unit, Universidad Nacional de Colombia, Bogota, Colombia
4 Professor of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
5 Professor of Medicine, Department of Internal Medicine, Rheumatology Unit, Universidad Nacional de Colombia, Bogota, Colombia
Journal of Autoimmune Diseases 2009, 6:1 doi:10.1186/1740-2557-6-1
Published: 27 February 2009Abstract
Introduction
Idiopathic systemic vasculitis represents a group of clinical entities having non-specific etiology with the common characteristic of acute or chronic inflammatory compromise of the small and large vessels walls, associated with fibrinoid necrosis.
Objectives
To describe the most common inflammatory vascular diseases in a long historical cohort of patients from San Juan de Dios Hospital located in Bogota, Colombia using two different systems and a clinical histopathological correlation format, and to make a comparison between them.
Methods
We reviewed all previously ascertained cases of vasculitis confirmed by biopsy processed between 1953 and 1990, and systematically collected data on all new cases of vasculitis from 1991 to 1997 at the Hospital San Juan de Dios (Bogota – Colombia). The cases were classified in accordance with the Chapel Hill Consensus criteria, and the system proposed by J.T. Lie.
Results
Of 165,556 biopsy tissue specimens obtained during this period from our hospital, 0.18% had vasculitis, perivasculitis or vasculopathy. These included 304 histopathological biopsies from 292 patients. Cutaneous leukocytoclastic vasculitis (64 histological specimens) was the most frequently encountered type of "primary" vasculitis followed by thromboangiitis obliterans (38 specimens), and polyarteritis nodosa (24 specimens). Vasculitis associated with connective tissue diseases (33 specimens) and infection (20 specimens) were the main forms of secondary vasculitis, a category that was omitted from the Chapel Hill consensus report. We found that 65.8% of our histopathological diagnoses could not be classified according to the Chapel Hill classification, and 35.2% could not be classified according to the classification of Lie. Only 8.9% of cases remained unclassified by our system after clinical and histological correlation.
Conclusion
Current vasculitis classification schemes are designed for classification, rather that diagnosis of disease and do not adequately address some common forms of inflammatory vascular diseases, including those of infectious etiology and unusual etiology seen in clinical practice. Based on our clinical experience, we suggest a classification outline which practitioners can use which emphasizes correlation of the clinical picture to the histopathology findings for diagnosis and therapy, which may promote better clinical practice and standardization for clinical trials.