23 results on '"Grayson, Peter C."'
Search Results
2. 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis.
- Author
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Ponte C, Grayson PC, Robson JC, Suppiah R, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Watts RA, Merkel PA, and Luqmani RA
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- Humans, Middle Aged, Prospective Studies, Temporal Arteries diagnostic imaging, Temporal Arteries pathology, Blood Sedimentation, Biopsy, Giant Cell Arteritis diagnostic imaging, Giant Cell Arteritis pathology, Rheumatology
- Abstract
Objective: To develop and validate updated classification criteria for giant cell arteritis (GCA)., Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in six phases: (1) identification of candidate items, (2) prospective collection of candidate items present at the time of diagnosis, (3) expert panel review of cases, (4) data-driven reduction of candidate items, (5) derivation of a points-based risk classification score in a development data set and (6) validation in an independent data set., Results: The development data set consisted of 518 cases of GCA and 536 comparators. The validation data set consisted of 238 cases of GCA and 213 comparators. Age ≥50 years at diagnosis was an absolute requirement for classification. The final criteria items and weights were as follows: positive temporal artery biopsy or temporal artery halo sign on ultrasound (+5); erythrocyte sedimentation rate ≥50 mm/hour or C reactive protein ≥10 mg/L (+3); sudden visual loss (+3); morning stiffness in shoulders or neck, jaw or tongue claudication, new temporal headache, scalp tenderness, temporal artery abnormality on vascular examination, bilateral axillary involvement on imaging and fluorodeoxyglucose-positron emission tomography activity throughout the aorta (+2 each). A patient could be classified as having GCA with a cumulative score of ≥6 points. When these criteria were tested in the validation data set, the model area under the curve was 0.91 (95% CI 0.88 to 0.94) with a sensitivity of 87.0% (95% CI 82.0% to 91.0%) and specificity of 94.8% (95% CI 91.0% to 97.4%)., Conclusion: The 2022 American College of Rheumatology/EULAR GCA classification criteria are now validated for use in clinical research., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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3. 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis.
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Grayson PC, Ponte C, Suppiah R, Robson JC, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Danda D, Luqmani RA, Watts RA, and Merkel PA
- Subjects
- Humans, Female, Middle Aged, Carotid Arteries, Cohort Studies, Intermittent Claudication, Takayasu Arteritis diagnostic imaging, Rheumatology
- Abstract
Objective: To develop and validate new classification criteria for Takayasu arteritis (TAK)., Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in six phases: (1) identification of candidate criteria items, (2) collection of candidate items present at diagnosis, (3) expert panel review of cases, (4) data-driven reduction of candidate items, (5) derivation of a points-based classification score in a development data set and (6) validation in an independent data set., Results: The development data set consisted of 316 cases of TAK and 323 comparators. The validation data set consisted of an additional 146 cases of TAK and 127 comparators. Age ≤60 years at diagnosis and imaging evidence of large-vessel vasculitis were absolute requirements to classify a patient as having TAK. The final criteria items and weights were as follows: female sex (+1), angina (+2), limb claudication (+2), arterial bruit (+2), reduced upper extremity pulse (+2), reduced pulse or tenderness of a carotid artery (+2), blood pressure difference between arms of ≥20 mm Hg (+1), number of affected arterial territories (+1 to +3), paired artery involvement (+1) and abdominal aorta plus renal or mesenteric involvement (+3). A patient could be classified as having TAK with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the model area under the curve was 0.97 (95% CI 0.94 to 0.99) with a sensitivity of 93.8% (95% CI 88.6% to 97.1%) and specificity of 99.2% (95% CI 96.7% to 100.0%)., Conclusion: The 2022 American College of Rheumatology/EULAR classification criteria for TAK are now validated for use in research., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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4. VEXAS Syndrome and Disease Taxonomy in Rheumatology.
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Grayson PC, Beck DB, Ferrada MA, Nigrovic PA, and Kastner DL
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- Rheumatology
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- 2022
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5. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease.
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Gorelik M, Chung SA, Ardalan K, Binstadt BA, Friedman K, Hayward K, Imundo LF, Lapidus SK, Kim S, Son MB, Sule S, Tremoulet AH, Van Mater H, Yildirim-Toruner C, Langford CA, Maz M, Abril A, Guyatt G, Archer AM, Conn DL, Full KA, Grayson PC, Ibarra MF, Merkel PA, Rhee RL, Seo P, Stone JH, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot M, Lin YC, Springer JM, Turgunbaev M, Villa-Forte A, Turner AS, and Mustafa RA
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- Evidence-Based Medicine, Humans, Immunoglobulins, Intravenous therapeutic use, Immunosuppressive Agents therapeutic use, United States, Mucocutaneous Lymph Node Syndrome diagnosis, Mucocutaneous Lymph Node Syndrome drug therapy, Rheumatology
- Abstract
Objective: To provide evidence-based recommendations and expert guidance for the management of Kawasaki disease (KD), focusing on clinical scenarios more commonly addressed by rheumatologists., Methods: Sixteen clinical questions regarding diagnostic testing, treatment, and management of KD were developed in the Patient/Population, Intervention, Comparison, and Outcomes (PICO) question format. Systematic literature reviews were conducted for each PICO question. We used the Grading of Recommendations, Assessment, Development and Evaluation method to assess the quality of evidence and formulate recommendations. Each recommendation required consensus from at least 70% of the Voting Panel., Results: We present 1 good practice statement, 11 recommendations, and 1 ungraded position statement to guide the management of KD and clinical scenarios of suspected KD. These recommendations for KD are focused on situations in which input from rheumatologists may be requested by other managing specialists, such as in cases of treatment-refractory, severe, or complicated KD. The good practice statement affirms that all patients with KD should receive initial treatment with intravenous immunoglobulin (IVIG). In addition, we developed 7 strong and 4 conditional recommendations for the management of KD or suspected KD. Strong recommendations include prompt treatment of incomplete KD, treatment with aspirin, and obtaining an echocardiogram in the setting of unexplained macrophage activation syndrome or shock. Conditional recommendations include use of IVIG with other adjuvant agents for patients with KD and high-risk features of IVIG resistance and/or coronary artery aneurysms. These recommendations endorse minimizing risk to the patient by using established therapy promptly at disease onset and identifying situations in which adjunctive therapy may be warranted., Conclusion: These recommendations provide guidance regarding diagnostic strategies, use of pharmacologic agents, and use of echocardiography in patients with suspected or confirmed KD., (© 2022 American College of Rheumatology. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)
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- 2022
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6. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Microscopic Polyangiitis.
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Suppiah R, Robson JC, Grayson PC, Ponte C, Craven A, Khalid S, Judge A, Hutchings A, Merkel PA, Luqmani RA, and Watts RA
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- Adult, Aged, Female, Humans, Male, Microscopic Polyangiitis classification, Microscopic Polyangiitis immunology, Middle Aged, Antibodies, Antineutrophil Cytoplasmic immunology, Microscopic Polyangiitis diagnosis, Rheumatology
- Abstract
Objective: To develop and validate classification criteria for microscopic polyangiitis (MPA)., Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 5 phases: 1) identification of candidate items using consensus methodology, 2) prospective collection of candidate items present at the time of diagnosis, 3) data-driven reduction of the number of candidate items, 4) expert panel review of cases to define the reference diagnosis, and 5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators., Results: The development set for MPA consisted of 149 cases of MPA and 408 comparators. The validation set consisted of an additional 142 cases of MPA and 414 comparators. From 91 candidate items, regression analysis identified 10 items for MPA, 6 of which were retained. The final criteria and their weights were as follows: perinuclear antineutrophil cytoplasmic antibody (ANCA) or anti-myeloperoxidase-ANCA positivity (+6), pauci-immune glomerulonephritis (+3), lung fibrosis or interstitial lung disease (+3), sino-nasal symptoms or signs (-3), cytoplasmic ANCA or anti-proteinase 3 ANCA positivity (-1), and eosinophil count ≥1 × 10
9 /liter (-4). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having MPA with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 91% (95% confidence interval [95% CI] 85-95%) and the specificity was 94% (95% CI 92-96%)., Conclusion: The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for MPA are now validated for use in clinical research., (© 2022 American College of Rheumatology.)- Published
- 2022
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7. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Granulomatosis With Polyangiitis.
- Author
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Robson JC, Grayson PC, Ponte C, Suppiah R, Craven A, Judge A, Khalid S, Hutchings A, Watts RA, Merkel PA, and Luqmani RA
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- Adult, Aged, Female, Granulomatosis with Polyangiitis classification, Humans, Male, Middle Aged, Granulomatosis with Polyangiitis diagnosis, Rheumatology
- Abstract
Objective: To develop and validate revised classification criteria for granulomatosis with polyangiitis (GPA)., Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 5 phases: 1) identification of candidate criteria items using consensus methodology, 2) prospective collection of candidate items present at the time of diagnosis, 3) data-driven reduction of the number of candidate items, 4) expert panel review of cases to define the reference diagnosis, and 5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators., Results: The development set for GPA consisted of 578 cases of GPA and 652 comparators. The validation set consisted of an additional 146 cases of GPA and 161 comparators. From 91 candidate items, regression analysis identified 26 items for GPA, 10 of which were retained. The final criteria and their weights were as follows: bloody nasal discharge, nasal crusting, or sino-nasal congestion (+3); cartilaginous involvement (+2); conductive or sensorineural hearing loss (+1); cytoplasmic antineutrophil cytoplasmic antibody (ANCA) or anti-proteinase 3 ANCA positivity (+5); pulmonary nodules, mass, or cavitation on chest imaging (+2); granuloma or giant cells on biopsy (+2); inflammation or consolidation of the nasal/paranasal sinuses on imaging (+1); pauci-immune glomerulonephritis (+1); perinuclear ANCA or antimyeloperoxidase ANCA positivity (-1); and eosinophil count ≥1 × 10
9 /liter (-4). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having GPA if the cumulative score was ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 93% (95% confidence interval [95% CI] 87-96%) and the specificity was 94% (95% CI 89-97%)., Conclusion: The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for GPA demonstrate strong performance characteristics and are validated for use in research., (© 2022 American College of Rheumatology.)- Published
- 2022
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8. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis.
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Grayson PC, Ponte C, Suppiah R, Robson JC, Craven A, Judge A, Khalid S, Hutchings A, Luqmani RA, Watts RA, and Merkel PA
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- Adult, Antibodies, Antineutrophil Cytoplasmic blood, Diagnosis, Differential, Europe, Female, Humans, Male, Middle Aged, Myeloblastin immunology, Prospective Studies, Reproducibility of Results, Risk Factors, Sensitivity and Specificity, Societies, United States, Eosinophilic Granuloma classification, Eosinophilic Granuloma diagnosis, Granulomatosis with Polyangiitis classification, Granulomatosis with Polyangiitis diagnosis, Rheumatology standards
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Objective: To develop and validate revised classification criteria for eosinophilic granulomatosis with polyangiitis (EGPA)., Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in five phases: (1) identification of candidate criteria items using consensus methodology, (2) prospective collection of candidate items present at the time of diagnosis, (3) data-driven reduction of the number of candidate items, (4) expert panel review of cases to define the reference diagnosis and (5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators., Results: The development set for EGPA consisted of 107 cases of EGPA and 450 comparators. The validation set consisted of an additional 119 cases of EGPA and 437 comparators. From 91 candidate items, regression analysis identified 11 items for EPGA, 7 of which were retained. The final criteria and their weights were as follows: maximum eosinophil count ≥1×10
9 /L (+5), obstructive airway disease (+3), nasal polyps (+3), cytoplasmic antineutrophil cytoplasmic antibody (ANCA) or anti-proteinase 3-ANCA positivity (-3), extravascular eosinophilic predominant inflammation (+2), mononeuritis multiplex/motor neuropathy not due to radiculopathy (+1) and haematuria (-1). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having EGPA if the cumulative score was ≥6 points. When these criteria were tested in the validation data set, the sensitivity was 85% (95% CI 77% to 91%) and the specificity was 99% (95% CI 98% to 100%)., Conclusion: The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis demonstrate strong performance characteristics and are validated for use in research., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2022
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9. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis.
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Maz M, Chung SA, Abril A, Langford CA, Gorelik M, Guyatt G, Archer AM, Conn DL, Full KA, Grayson PC, Ibarra MF, Imundo LF, Kim S, Merkel PA, Rhee RL, Seo P, Stone JH, Sule S, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot MA, Lin YC, Springer JM, Turgunbaev M, Villa-Forte A, Turner AS, and Mustafa RA
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- Clinical Decision-Making, Consensus, Decision Support Techniques, Drug Therapy, Combination, Evidence-Based Medicine standards, Giant Cell Arteritis diagnosis, Giant Cell Arteritis immunology, Glucocorticoids adverse effects, Humans, Immunosuppressive Agents adverse effects, Takayasu Arteritis diagnosis, Takayasu Arteritis immunology, Treatment Outcome, Giant Cell Arteritis drug therapy, Glucocorticoids therapeutic use, Immunosuppressive Agents therapeutic use, Rheumatology standards, Takayasu Arteritis drug therapy
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Objective: To provide evidence-based recommendations and expert guidance for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) as exemplars of large vessel vasculitis., Methods: Clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for GCA and TAK (27 for GCA, 27 for TAK). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. Recommendations were developed by the Voting Panel, comprising adult and pediatric rheumatologists and patients. Each recommendation required ≥70% consensus among the Voting Panel., Results: We present 22 recommendations and 2 ungraded position statements for GCA, and 20 recommendations and 1 ungraded position statement for TAK. These recommendations and statements address clinical questions relating to the use of diagnostic testing, including imaging, treatments, and surgical interventions in GCA and TAK. Recommendations for GCA include support for the use of glucocorticoid-sparing immunosuppressive agents and the use of imaging to identify large vessel involvement. Recommendations for TAK include the use of nonglucocorticoid immunosuppressive agents with glucocorticoids as initial therapy. There were only 2 strong recommendations; the remaining recommendations were conditional due to the low quality of evidence available for most PICO questions., Conclusion: These recommendations provide guidance regarding the evaluation and management of patients with GCA and TAK, including diagnostic strategies, use of pharmacologic agents, and surgical interventions., (© 2021 American College of Rheumatology. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)
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- 2021
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10. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Polyarteritis Nodosa.
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Chung SA, Gorelik M, Langford CA, Maz M, Abril A, Guyatt G, Archer AM, Conn DL, Full KA, Grayson PC, Ibarra MF, Imundo LF, Kim S, Merkel PA, Rhee RL, Seo P, Stone JH, Sule S, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot M, Lin YC, Springer JM, Turgunbaev M, Villa-Forte A, Turner AS, and Mustafa RA
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- Cyclophosphamide therapeutic use, Disease Management, Glucocorticoids therapeutic use, Humans, United States, Antirheumatic Agents therapeutic use, Evidence-Based Medicine standards, Polyarteritis Nodosa diagnosis, Polyarteritis Nodosa diagnostic imaging, Polyarteritis Nodosa drug therapy, Rheumatology standards
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Objective: To provide evidence-based recommendations and expert guidance for the management of systemic polyarteritis nodosa (PAN)., Methods: Twenty-one clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for systemic, non-hepatitis B-related PAN. Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of evidence and formulate recommendations. Each recommendation required ≥70% consensus among the Voting Panel., Results: We present 16 recommendations and 1 ungraded position statement for PAN. Most recommendations were graded as conditional due to the paucity of evidence. These recommendations support early treatment of severe PAN with cyclophosphamide and glucocorticoids, limiting toxicity through minimizing long-term exposure to both treatments, and the use of imaging and tissue biopsy for disease diagnosis. These recommendations endorse minimizing risk to the patient by using established therapy at disease onset and identify new areas where adjunctive therapy may be warranted., Conclusion: These recommendations provide guidance regarding diagnostic strategies, use of pharmacologic agents, and imaging for patients with PAN., (© 2021 American College of Rheumatology. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)
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- 2021
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11. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.
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Chung SA, Langford CA, Maz M, Abril A, Gorelik M, Guyatt G, Archer AM, Conn DL, Full KA, Grayson PC, Ibarra MF, Imundo LF, Kim S, Merkel PA, Rhee RL, Seo P, Stone JH, Sule S, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot MA, Lin YC, Springer JM, Turgunbaev M, Villa-Forte A, Turner AS, and Mustafa RA
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- Antibodies, Monoclonal, Humanized therapeutic use, Churg-Strauss Syndrome diagnosis, Churg-Strauss Syndrome drug therapy, Disease Management, Granulomatosis with Polyangiitis diagnosis, Granulomatosis with Polyangiitis drug therapy, Humans, Microscopic Polyangiitis diagnosis, Microscopic Polyangiitis drug therapy, Remission Induction, Rituximab therapeutic use, United States, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis diagnosis, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis drug therapy, Antirheumatic Agents therapeutic use, Evidence-Based Medicine standards, Rheumatology standards
- Abstract
Objective: To provide evidence-based recommendations and expert guidance for the management of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA)., Methods: Clinical questions regarding the treatment and management of AAV were developed in the population, intervention, comparator, and outcome (PICO) format (47 for GPA/MPA, 34 for EGPA). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of evidence and formulate recommendations. Each recommendation required ≥70% consensus among the Voting Panel., Results: We present 26 recommendations and 5 ungraded position statements for GPA/MPA, and 15 recommendations and 5 ungraded position statements for EGPA. This guideline provides recommendations for remission induction and maintenance therapy as well as adjunctive treatment strategies in GPA, MPA, and EGPA. These recommendations include the use of rituximab for remission induction and maintenance in severe GPA and MPA and the use of mepolizumab in nonsevere EGPA. All recommendations are conditional due in part to the lack of multiple randomized controlled trials and/or low-quality evidence supporting the recommendations., Conclusion: This guideline presents the first recommendations endorsed by the American College of Rheumatology and the Vasculitis Foundation for the management of AAV and provides guidance to health care professionals on how to treat these diseases., (© 2021, American College of Rheumatology.)
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- 2021
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12. Use of "Provisional" Designation for Response Criteria.
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Johnson SR and Grayson PC
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- Child, Humans, United States, Lupus Erythematosus, Systemic, Rheumatology
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- 2018
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13. Are the 1990 American College of Rheumatology vasculitis classification criteria still valid?
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Seeliger B, Sznajd J, Robson JC, Judge A, Craven A, Grayson PC, Suppiah RS, Watts RA, Merkel PA, and Luqmani RA
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- Aged, Cohort Studies, Databases, Factual, Female, Granulomatosis with Polyangiitis classification, Granulomatosis with Polyangiitis diagnosis, Humans, Male, Middle Aged, Polyarteritis Nodosa classification, Polyarteritis Nodosa diagnosis, Retrospective Studies, Sensitivity and Specificity, Societies, Medical, Systemic Vasculitis diagnosis, Takayasu Arteritis classification, Takayasu Arteritis diagnosis, Time Factors, United States, Rheumatology standards, Systemic Vasculitis classification
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Objectives: Advances in diagnostic techniques have led to better distinction between types of vasculitis, potentially affecting the utility of the 1990 ACR classification criteria for vasculitis. This study tested the performance of these criteria in a contemporary vasculitis cohort., Methods: The Diagnosis and Classification in Vasculitis Study provided detailed clinical, serological, pathological and radiological data from patients with primary systemic vasculitis and clinical context-specific comparator conditions. Fulfilment of six ACR criteria sets and their diagnostic performance was evaluated in patients with a given type of vasculitis and its comparator conditions., Results: Data from 1095 patients with primary systemic vasculitis and 415 with comparator conditions were available. For classification, sensitivities and specificities for ACR classification criteria were, respectively, 81.1% and 94.9% for GCA; 73.6% and 98.3% for Takayasu's arteritis; 65.6% and 88.7% for granulomatosis with polyangiitis; 57.0% and 99.8% for eosinophilic granulomatosis with polyangiitis; 40.6% and 87.8% for polyarteritis nodosa; 28.9% and 88.5% for microscopic polyangiitis; and 72.7% and 96.3% for IgA-vasculitis. Overall sensitivity was 67.1%. Of cases identified by their respective criteria, 16.9% also met criteria for other vasculitides. Diagnostic specificity ranged from 64.2 to 98.9%; overall, 113/415 comparators (27.2%) fulfilled at least one of the ACR classification criteria sets., Conclusion: Since publication of the ACR criteria for vasculitis, the sensitivity for each type of vasculitis, except GCA, has diminished, although the specificities have remained high, highlighting the need for updated classification criteria., (© The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com)
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- 2017
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14. Musculoskeletal ultrasound objective structured clinical examination: an assessment of the test.
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Kissin EY, Grayson PC, Cannella AC, Demarco PJ, Evangelisto A, Goyal J, Al Haj R, Higgs J, Malone DG, Nishio MJ, Tabechian D, and Kaeley GS
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- Ankle Joint diagnostic imaging, Clinical Competence, Education, Medical, Continuing methods, Humans, Observer Variation, Reproducibility of Results, Wrist Joint diagnostic imaging, Educational Measurement methods, Musculoskeletal Diseases diagnosis, Musculoskeletal Diseases diagnostic imaging, Musculoskeletal System diagnostic imaging, Rheumatology education, Ultrasonography methods
- Abstract
Objective: To determine the reliability and validity of an objective structured clinical examination (OSCE) for musculoskeletal ultrasound (MSUS)., Methods: A 9-station OSCE was administered to 35 rheumatology fellows trained in MSUS and to 3 expert faculty (controls). Participants were unaware of joint health (5 diseased/4 healthy). Faculty assessors (n = 9) graded image quality with predefined checklists and a 0-5 global rating, blinded to who performed the study. Interrater reliability, correlation between a written multiple choice question examination (MCQ) and OSCE performance, and comparison of fellow OSCE results with those of the faculty were measured to determine OSCE reliability, concurrent validity, and construct validity., Results: Assessors' interrater reliability was good (intraclass correlation coefficient [ICC] 0.7). Score reliability was good in the normal wrist and ankle stations (ICC 0.7) and moderate in the abnormal wrist and ankle stations (ICC 0.4). MCQ grades significantly correlated with OSCE grades (r = 0.52, P < 0.01). The fellows in the bottom quartile of the MCQ scored 3.07 on the OSCE, significantly worse than the top quartile fellows (3.32) and the faculty (3.29; P < 0.01). Scores also significantly discriminated bottom quartile fellows from faculty in the normal wrist and ankle stations (3.38 versus 3.78; P < 0.01), but not in the abnormal stations (3.37 versus 3.49; P = 0.08)., Conclusion: MSUS OSCE is a reliable and valid method for evaluation of MSUS skill. Normal joint assessment stations are more reliable than abnormal joint assessment stations and better discriminate poorly performing fellows from faculty. Therefore, MSUS OSCE with normal joints can be used for the assessment of MSUS skill competency., (Copyright © 2014 by the American College of Rheumatology.)
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- 2014
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15. Identification of new risk loci shared across systemic vasculitides points towards potential target genes for drug repurposing
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Ortiz-Fernández, Lourdes, Carmona, Elio G, Kerick, Martin, Lyons, Paul, Carmona, Francisco David, López Mejías, Raquel, Khor, Chiea Chuen, Grayson, Peter C, Tombetti, Enrico, Jiang, Lindi, Direskeneli, Haner, Saruhan-Direskeneli, Guher, Callejas-Rubio, José-Luis, Vaglio, Augusto, Salvarani, Carlo, Hernández-Rodríguez, Jose, Cid, Maria Cinta, Morgan, Ann W, Merkel, Peter A, Burgner, David, Smith, Kenneth Gc, Gonzalez-Gay, Miguel Angel, Sawalha, Amr H, Martin, Javier, Marquez, Ana, Ortiz-Fernández, Lourdes [0000-0002-0247-4280], Carmona, Francisco David [0000-0002-1427-7639], Grayson, Peter C [0000-0002-8269-9438], Salvarani, Carlo [0000-0003-3708-3148], Hernández-Rodríguez, Jose [0000-0002-2357-2015], Cid, Maria Cinta [0000-0002-4730-0938], Gonzalez-Gay, Miguel Angel [0000-0002-7924-7406], Martin, Javier [0000-0002-2202-0622], Marquez, Ana [0000-0001-9913-7688], Apollo - University of Cambridge Repository, and Ortiz-Fernandez L., Carmona E. G., Kerick M., Lyons P., Carmona F. D., Mejias R. L., Khor C. C., Grayson P. C., Tombetti E., Jiang L., et al.
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Internal Diseases ,Vasculitis ,Immunology ,Autoimmunity ,SUSCEPTIBILITY ,VARIANTS ,Sağlık Bilimleri ,İmmünoloji ve Romatoloji ,İç Hastalıkları ,Clinical Medicine (MED) ,General Biochemistry, Genetics and Molecular Biology ,Immunology and Rheumatology ,ACTIVATION ,Genetic ,Rheumatology ,Health Sciences ,Humans ,Immunology and Allergy ,Klinik Tıp (MED) ,CTLA-4 Antigen ,Genetic Predisposition to Disease ,Polymorphism ,GENOME-WIDE ASSOCIATION ,ROMATOLOJİ ,Internal Medicine Sciences ,Polymorphism, Genetic ,Klinik Tıp ,Systemic Vasculitis ,Drug Repositioning ,Dahili Tıp Bilimleri ,CLINICAL MEDICINE ,Tıp ,Medicine ,Romatoloji ,Apoptosis Regulatory Proteins - Abstract
Objectives The number of susceptibility loci currently associated with vasculitis is lower than in other immune-mediated diseases due in part to small cohort sizes, a consequence of the low prevalence of vasculitides. This study aimed to identify new genetic risk loci for the main systemic vasculitides through a comprehensive analysis of their genetic overlap. Methods Genome-wide data from 8467 patients with any of the main forms of vasculitis and 29 795 healthy controls were meta-analysed using ASSET. Pleiotropic variants were functionally annotated and linked to their target genes. Prioritised genes were queried in DrugBank to identify potentially repositionable drugs for the treatment of vasculitis. Results Sixteen variants were independently associated with two or more vasculitides, 15 of them representing new shared risk loci. Two of these pleiotropic signals, located close to CTLA4 and CPLX1, emerged as novel genetic risk loci in vasculitis. Most of these polymorphisms appeared to affect vasculitis by regulating gene expression. In this regard, for some of these common signals, potential causal genes were prioritised based on functional annotation, including CTLA4, RNF145, IL12B, IL5, IRF1, IFNGR1, PTK2B, TRIM35, EGR2 and ETS2, each of which has key roles in inflammation. In addition, drug repositioning analysis showed that several drugs, including abatacept and ustekinumab, could be potentially repurposed in the management of the analysed vasculitides. Conclusions We identified new shared risk loci with functional impact in vasculitis and pinpointed potential causal genes, some of which could represent promising targets for the treatment of vasculitis., HELICAL Innovative Training Network, European Commission funded-under the Marie Sklodowska-Curie 813545, Cooperative Research Thematic Network programme RD16/0012/0013, Redes de Investigacion Cooperativa Orientadas a Resultados en Salud (RICORS) RD21/0002/0039, Instituto de Salud Carlos III PI18/00040, Juan de la Cierva Incorporacion fellowship IJC2019- 040746-I, United States Department of Health & Human Services, National Institutes of Health (NIH) - USA, NIH National Institute of Arthritis & Musculoskeletal & Skin Diseases (NIAMS) R01 AR070148, National Health and Medical Research Council (NHMRC) of Australia GTN1175744, Victorian Government's Operational Infrastructure Support Program, Rare Diseases Clinical Research Network (RDCRN), initiative of the Office of Rare Diseases Research (ORDR), NIH National Center for Advancing Translational Sciences (NCATS), NIH National Institute of Arthritis & Musculoskeletal & Skin Diseases (NIAMS) U54 AR057319, NIH National Center for Research Resources (NCRR) U54 RR019497
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- 2023
16. Reply.
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Ponte, Cristina, Grayson, Peter C., Gribbons, Katherine Bates, Robson, Joanna C., Suppiah, Ravi, Judge, Andrew, Watts, Richard A., Luqmani, Raashid A., and Merkel, Peter A.
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NURSES' associations , *GIANT cell arteritis diagnosis , *AGE distribution , *RHEUMATOLOGY , *GIANT cell arteritis , *TAKAYASU arteritis , *PHENOTYPES - Published
- 2023
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17. 2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis.
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Grayson, Peter C., Ponte, Cristina, Suppiah, Ravi, Robson, Joanna C., Gribbons, Katherine Bates, Judge, Andrew, Craven, Anthea, Khalid, Sara, Hutchings, Andrew, Danda, Debashish, Luqmani, Raashid A., Watts, Richard A., Merkel, Peter A., Gatenby, Paul, Hill, Catherine, Ranganathan, Dwarakanathan, Kronbichler, Andreas, Blockmans, Daniel, Barra, Lillian, and Carette, Simon
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BLOOD pressure , *CONFIDENCE intervals , *RHEUMATOLOGY , *AGE distribution , *ANGINA pectoris , *TAKAYASU arteritis , *DIAGNOSTIC imaging , *SEX distribution , *DESCRIPTIVE statistics , *SENSITIVITY & specificity (Statistics) , *VASCULITIS , *INTERMITTENT claudication , *PULSE (Heart beat) - Abstract
Objective: To develop and validate new classification criteria for Takayasu arteritis (TAK). Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 6 phases: 1) identification of candidate criteria items, 2) collection of candidate items present at diagnosis, 3) expert panel review of cases, 4) data‐driven reduction of candidate items, 5) derivation of a points‐based classification score in a development data set, and 6) validation in an independent data set. Results: The development data set consisted of 316 cases of TAK and 323 comparators. The validation data set consisted of an additional 146 cases of TAK and 127 comparators. Age ≤60 years at diagnosis and imaging evidence of large‐vessel vasculitis were absolute requirements to classify a patient as having TAK. The final criteria items and weights were as follows: female sex (+1), angina (+2), limb claudication (+2), arterial bruit (+2), reduced upper extremity pulse (+2), reduced pulse or tenderness of a carotid artery (+2), blood pressure difference between arms of ≥20 mm Hg (+1), number of affected arterial territories (+1 to +3), paired artery involvement (+1), and abdominal aorta plus renal or mesenteric involvement (+3). A patient could be classified as having TAK with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the model area under the curve was 0.97 (95% confidence interval [95% CI] 0.94–0.99) with a sensitivity of 93.8% (95% CI 88.6–97.1%) and specificity of 99.2% (95% CI 96.7–100.0%). Conclusion: The 2022 American College of Rheumatology/EULAR classification criteria for TAK are now validated for use in research. [ABSTRACT FROM AUTHOR]
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- 2022
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18. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis With Polyangiitis.
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Grayson, Peter C., Ponte, Cristina, Suppiah, Ravi, Robson, Joanna C., Craven, Anthea, Judge, Andrew, Khalid, Sara, Hutchings, Andrew, Luqmani, Raashid A., Watts, Richard A., Merkel, Peter A., Gatenby, Paul, Hill, Catherine, Ranganathan, Dwarakanathan, Kronbichler, Andreas, Blockmans, Daniel, Barra, Lillian, Carette, Simon, Pagnoux, Christian, and Dhindsa, Navjot
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CONSENSUS (Social sciences) , *EOSINOPHILS , *CONFIDENCE intervals , *RHEUMATOLOGY , *RESEARCH methodology , *PARANASAL sinus diseases , *ANTINEUTROPHIL cytoplasmic antibodies , *CHURG-Strauss syndrome , *DESCRIPTIVE statistics , *LOGISTIC regression analysis , *SENSITIVITY & specificity (Statistics) - Abstract
Objective: To develop and validate revised classification criteria for eosinophilic granulomatosis with polyangiitis (EGPA). Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 5 phases: 1) identification of candidate criteria items using consensus methodology, 2) prospective collection of candidate items present at the time of diagnosis, 3) data‐driven reduction of the number of candidate items, 4) expert panel review of cases to define the reference diagnosis, and 5) derivation of a points‐based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. Results: The development set for EGPA consisted of 107 cases of EGPA and 450 comparators. The validation set consisted of an additional 119 cases of EGPA and 437 comparators. From 91 candidate items, regression analysis identified 11 items for EPGA, 7 of which were retained. The final criteria and their weights were as follows: maximum eosinophil count ≥1 × 109/liter (+5), obstructive airway disease (+3), nasal polyps (+3), cytoplasmic antineutrophil cytoplasmic antibody (ANCA) or anti–proteinase 3 ANCA positivity (−3), extravascular eosinophilic predominant inflammation (+2), mononeuritis multiplex/motor neuropathy not due to radiculopathy (+1), and hematuria (−1). After excluding mimics of vasculitis, a patient with a diagnosis of small‐ or medium‐vessel vasculitis could be classified as having EGPA if the cumulative score was ≥6 points. When these criteria were tested in the validation data set, the sensitivity was 85% (95% confidence interval [95% CI] 77–91%) and the specificity was 99% (95% CI 98–100%). Conclusion: The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for EGPA demonstrate strong performance characteristics and are validated for use in research. [ABSTRACT FROM AUTHOR]
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- 2022
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19. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis.
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Suppiah, Ravi, Robson, Joanna C., Grayson, Peter C., Ponte, Cristina, Craven, Anthea, Khalid, Sara, Judge, Andrew, Hutchings, Andrew, Merkel, Peter A., Luqmani, Raashid A., Watts, Richard A., and DCVAS INVESTIGATORS
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AUTOANTIBODIES ,RESEARCH ,BIOPSY ,RESEARCH evaluation ,RHEUMATOLOGY ,RESEARCH methodology ,PROTEOLYTIC enzymes ,DIFFERENTIAL diagnosis ,EVALUATION research ,COMPARATIVE studies ,SENSITIVITY & specificity (Statistics) ,PROFESSIONAL associations ,OXIDOREDUCTASES ,VASCULITIS ,LONGITUDINAL method - Abstract
Objective: To develop and validate classification criteria for microscopic polyangiitis (MPA).Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in five phases: (1) identification of candidate items using consensus methodology, (2) prospective collection of candidate items present at the time of diagnosis, (3) data-driven reduction of the number of candidate items, (4) expert panel review of cases to define the reference diagnosis and (5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators.Results: The development set for MPA consisted of 149 cases of MPA and 408 comparators. The validation set consisted of an additional 142 cases of MPA and 414 comparators. From 91 candidate items, regression analysis identified 10 items for MPA, 6 of which were retained. The final criteria and their weights were as follows: perinuclear antineutrophil cytoplasmic antibody (ANCA) or anti-myeloperoxidase-ANCA positivity (+6), pauci-immune glomerulonephritis (+3), lung fibrosis or interstitial lung disease (+3), sino-nasal symptoms or signs (-3), cytoplasmic ANCA or anti-proteinase 3 ANCA positivity (-1) and eosinophil count ≥1×109/L (-4). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having MPA with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 91% (95% CI 85% to 95%) and the specificity was 94% (95% CI 92% to 96%).Conclusion: The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for MPA are now validated for use in clinical research. [ABSTRACT FROM AUTHOR]- Published
- 2022
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20. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.
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Chung, Sharon A., Langford, Carol A., Maz, Mehrdad, Abril, Andy, Gorelik, Mark, Guyatt, Gordon, Archer, Amy M., Conn, Doyt L., Full, Kathy A., Grayson, Peter C., Ibarra, Maria F., Imundo, Lisa F., Kim, Susan, Merkel, Peter A., Rhee, Rennie L., Seo, Philip, Stone, John H., Sule, Sangeeta, Sundel, Robert P., and Vitobaldi, Omar I.
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VASCULITIS ,VASCULAR diseases ,ANTINEUTROPHIL cytoplasmic antibodies ,AUTOANTIBODIES ,CHURG-Strauss syndrome ,AUTOIMMUNE disease diagnosis ,CONSENSUS (Social sciences) ,RHEUMATOLOGY ,AUTOIMMUNE diseases ,EVIDENCE-based medicine ,SEVERITY of illness index ,TREATMENT effectiveness ,DECISION making ,IMMUNOSUPPRESSIVE agents - Abstract
Objective: To provide evidence-based recommendations and expert guidance for the management of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA).Methods: Clinical questions regarding the treatment and management of AAV were developed in the population, intervention, comparator, and outcome (PICO) format (47 for GPA/MPA, 34 for EGPA). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of evidence and formulate recommendations. Each recommendation required ≥70% consensus among the Voting Panel.Results: We present 26 recommendations and 5 ungraded position statements for GPA/MPA, and 15 recommendations and 5 ungraded position statements for EGPA. This guideline provides recommendations for remission induction and maintenance therapy as well as adjunctive treatment strategies in GPA, MPA, and EGPA. These recommendations include the use of rituximab for remission induction and maintenance in severe GPA and MPA and the use of mepolizumab in nonsevere EGPA. All recommendations are conditional due in part to the lack of multiple randomized controlled trials and/or low-quality evidence supporting the recommendations.Conclusion: This guideline presents the first recommendations endorsed by the American College of Rheumatology and the Vasculitis Foundation for the management of AAV and provides guidance to health care professionals on how to treat these diseases. [ABSTRACT FROM AUTHOR]- Published
- 2021
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21. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Polyarteritis Nodosa.
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Chung, Sharon A., Gorelik, Mark, Langford, Carol A., Maz, Mehrdad, Abril, Andy, Guyatt, Gordon, Archer, Amy M., Conn, Doyt L., Full, Kathy A., Grayson, Peter C., Ibarra, Maria F., Imundo, Lisa F., Kim, Susan, Merkel, Peter A., Rhee, Rennie L., Seo, Philip, Stone, John H., Sule, Sangeeta, Sundel, Robert P., and Vitobaldi, Omar I.
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POLYARTERITIS nodosa ,ARTERITIS ,COLLAGEN diseases ,RHEUMATOLOGY ,JOINT diseases ,THERAPEUTIC use of glucocorticoids ,GLUCOCORTICOIDS ,CONSENSUS (Social sciences) ,RESEARCH ,COMBINATION drug therapy ,RESEARCH methodology ,EVIDENCE-based medicine ,MEDICAL cooperation ,EVALUATION research ,SEVERITY of illness index ,TREATMENT effectiveness ,COMPARATIVE studies ,CYCLOPHOSPHAMIDE ,DECISION making ,IMMUNOSUPPRESSIVE agents - Abstract
Objective: To provide evidence-based recommendations and expert guidance for the management of systemic polyarteritis nodosa (PAN).Methods: Twenty-one clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for systemic, non-hepatitis B-related PAN. Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of evidence and formulate recommendations. Each recommendation required ≥70% consensus among the Voting Panel.Results: We present 16 recommendations and 1 ungraded position statement for PAN. Most recommendations were graded as conditional due to the paucity of evidence. These recommendations support early treatment of severe PAN with cyclophosphamide and glucocorticoids, limiting toxicity through minimizing long-term exposure to both treatments, and the use of imaging and tissue biopsy for disease diagnosis. These recommendations endorse minimizing risk to the patient by using established therapy at disease onset and identify new areas where adjunctive therapy may be warranted.Conclusion: These recommendations provide guidance regarding diagnostic strategies, use of pharmacologic agents, and imaging for patients with PAN. [ABSTRACT FROM AUTHOR]- Published
- 2021
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22. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis.
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Maz, Mehrdad, Chung, Sharon A., Abril, Andy, Langford, Carol A., Gorelik, Mark, Guyatt, Gordon, Archer, Amy M., Conn, Doyt L., Full, Kathy A., Grayson, Peter C., Ibarra, Maria F., Imundo, Lisa F., Kim, Susan, Merkel, Peter A., Rhee, Rennie L., Seo, Philip, Stone, John H., Sule, Sangeeta, Sundel, Robert P., and Vitobaldi, Omar I.
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GIANT cell arteritis diagnosis ,UNIVERSITIES & colleges ,CONSENSUS (Social sciences) ,RHEUMATOLOGY ,GIANT cell arteritis ,EVIDENCE-based medicine ,MEDICAL personnel ,VOTING ,TAKAYASU arteritis ,MEDICAL protocols ,RHEUMATOLOGISTS ,PATIENTS' attitudes ,DIAGNOSTIC imaging ,EXPERTISE ,IMMUNOSUPPRESSIVE agents ,DISEASE management - Abstract
Objective: To provide evidence‐based recommendations and expert guidance for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) as exemplars of large vessel vasculitis. Methods: Clinical questions regarding diagnostic testing, treatment, and management were developed in the population, intervention, comparator, and outcome (PICO) format for GCA and TAK (27 for GCA, 27 for TAK). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. Recommendations were developed by the Voting Panel, comprising adult and pediatric rheumatologists and patients. Each recommendation required ≥70% consensus among the Voting Panel. Results: We present 22 recommendations and 2 ungraded position statements for GCA, and 20 recommendations and 1 ungraded position statement for TAK. These recommendations and statements address clinical questions relating to the use of diagnostic testing, including imaging, treatments, and surgical interventions in GCA and TAK. Recommendations for GCA include support for the use of glucocorticoid‐sparing immunosuppressive agents and the use of imaging to identify large vessel involvement. Recommendations for TAK include the use of nonglucocorticoid immunosuppressive agents with glucocorticoids as initial therapy. There were only 2 strong recommendations; the remaining recommendations were conditional due to the low quality of evidence available for most PICO questions. Conclusion: These recommendations provide guidance regarding the evaluation and management of patients with GCA and TAK, including diagnostic strategies, use of pharmacologic agents, and surgical interventions. [ABSTRACT FROM AUTHOR]
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- 2021
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23. Reply.
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Grayson, Peter C., Ponte, Cristina, Robson, Joanna C., Suppiah, Ravi, Judge, Andrew, Hutchings, Andrew, Craven, Anthea, Khalid, Sara, Luqmani, Raashid A., Watts, Richard A., and Merkel, Peter A.
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RHEUMATOLOGY , *ANTINEUTROPHIL cytoplasmic antibodies , *VASCULITIS , *MICROSCOPIC polyangiitis - Published
- 2022
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