Set Of Classification Criteria Research Articles

A History of Polymyalgia Rheumatica: A Narrative Review.

Polymyalgia rheumatica (PMR) is characterised by stiffness and pain in the shoulders, hips, and neck and presents most commonly in the eighth decade. It can coexist with giant cell arteritis and the two diseases may share some pathophysiological mechanisms. This narrative review considers present-day ideas about PMR in a historical context, from the first names and descriptions of this disease entity, via successive generations of classification criteria sets, and finally to implications for clinical diagnosis. The characteristic distribution of musculoskeletal inflammation in PMR, and its relationship to vasculitic and synovitic diseases, have framed the way that PMR is described, classified, diagnosed and treated. A response to glucocorticoids is not specific to PMR and so it is important for rheumatologists to support general practitioners in making a definite diagnosis. Multi-stakeholder collaboration will improve current pathways for fast, accurate diagnosis and safe and effective treatment.

The IACOB project

Context. With the advent of large spectroscopic surveys, automated stellar parameter determination has become commonplace. Nevertheless, spectral classification still offers a quick and useful alternative for obtaining parameter estimates for large samples of spectra of varying quality. Aims. We present a new atlas of stellar spectra covering the B-type range, with the intention of providing detailed classification criteria valid for modern spectra and improving the grid of reliable standards. This new grid will be used in future works to provide classification criteria beyond the classical classification range and addressing, in particular, the use of Gaia/RVS spectra. Methods. We analysed historical standards by means of multiple high-resolution spectra, marking out problematic cases and complementing the grid with a new set of reliable comparators. We then elaborated on a new set of classification criteria based on high-quality R = 4000 spectra. Results. Our new classification grid is much thicker than any previous set of standards, presenting a high degree of self-consistency. Although it is based entirely on morphological criteria, the grid demonstrates a much better correlation with different physical parameters. Conclusions. The new grid can be used to study classification criteria in other spectral ranges, providing a valuable tool for the study of B-type stars that covers a very wide range of temperatures, luminosities, and stellar masses. The very process of classification also offers valuable insights into stellar evolution.

IIVRS: an Intelligent Image and Video Rating System to Provide Scenario-Based Content for Different Users

Abstract Voice Intelligent Assistants provide users with new ways of human-computer interaction. With built-in screens, Voice Intelligent Assistants can display images and videos upon users’ requests. Even though images and videos present information in a lively manner, they might also contain overwhelming harmful contents. Due to the lack of effective evaluation mechanisms, it is difficult to prevent the propagation of harmful contents while ensuring the dissemination of compliant visual contents. This research defined a standardized set of classification criteria to identify and classify harmful visual contents. Then, Intelligent Image and Video Rating System, a prototype rating system that implemented the classification criteria was designed and developed. This research further evaluated and verified the reliability and efficiency of the prototype. The prototype system demonstrated additional advantages in swiftly classifying new hazardous contents, and in differentiating the multiple meanings of the same object in different contexts.

Clinical Manifestations and Prognosis of Giant Cell Arteritis: A Retrospective Cohort Study.

. A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory, and instrumental data and three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Rheumatologic Associations (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n = 61), contrast-enhanced computed tomography (n = 5), CT angiography (n = 6), magnetic resonance imaging (n = 4), MR angiography (n = 3), and 18F-FDG PET/CT (n = 47). Overall and recurrence-free survival rates were analyzed using survival tables and Kaplan-Meier method. . The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%), and symptoms of rheumatic polymyalgia (56.6%). Changes in temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n = 158), methotrexate was used in 49 out of 158 patients, leflunomide in 9 patients. In 45 (28.5%) out of 158 patients, a stable remission was achieved as a result of GC monotherapy; in 120 (75.9%) patients, long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0-54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% CI 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI 42.0; 62.8]. Twelve (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined. : Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.

Classification Criteria for ANCA Associated Vasculitis - Ready for Prime Time?

This review aims to summarize the evolution and recent developments in the classification of ANCA associated vasculitis (AAV) and to summarize evaluations of the 2022 ACR/EULAR classification criteria of AAV in several cohorts. The classification of AAV has been a field of controversy for some time. The parallel existence of classification criteria and disease definitions produced some overlap in classification, leading to challenges when comparing different cohorts. The 2022 ACR/EULAR classification criteria derived from the largest study ever conducted in vasculitis account for significant changes in vasculitis classification with the integration of ANCA and modern imaging. These criteria show good performance compared to previous ones but also raise questions as ANCA serotypes have substantial impact on classification. In addition, there are some discrepancies with earlier agreed histopathological features of AAV disease phenotypes. During the last 35years, several sets of classification criteria have evolved to facilitate epidemiologic studies and clinical trials in AAV. While some of these criteria have been in use for many years, they were criticized due to either not using ANCA or not integrating surrogate markers for vasculitis but also due to overlapping when used in parallel. The long-awaited new ACR/EULAR criteria for AAV were published in 2022 and are the result of a large international study, introducing for the first time ANCA and modern imaging in the classification of AAV. Though the criteria show good performance, they bring several other challenges with practical application.

Km‐Scale Simulations of Mesoscale Convective Systems Over South America—A Feature Tracker Intercomparison

AbstractMesoscale convective systems (MCSs) are clusters of thunderstorms that are important in Earth's water and energy cycle. Additionally, they are responsible for extreme events such as large hail, strong winds, and extreme precipitation. Automated object‐based analyses that track MCSs have become popular since they allow us to identify and follow MCSs over their entire life cycle in a Lagrangian framework. This rise in popularity was accompanied by an increasing number of MCS tracking algorithms, however, little is known about how sensitive analyses are concerning the MCS tracker formulation. Here, we assess differences between six MCS tracking algorithms on South American MCS characteristics and evaluate MCSs in kilometer‐scale simulations with observational‐based MCSs over 3 years. All trackers are run with a common set of MCS classification criteria to isolate tracker formulation differences. The tracker formulation substantially impacts MCS characteristics such as frequency, size, duration, and contribution to total precipitation. The evaluation of simulated MCS characteristics is less sensitive to the tracker formulation and all trackers agree that the model can capture MCS characteristics well across different South American climate zones. Dominant sources of uncertainty are the segmentation of cloud systems in space and time and the treatment of how MCSs are linked in time. Our results highlight that comparing MCS analyses that use different tracking algorithms is challenging. We provide general guidelines on how MCS characteristics compare between trackers to facilitate a more robust assessment of MCS statistics in future studies.

Prevalence of concomitant rheumatologic diseases and autoantibody specificities among racial and ethnic groups in SLE patients.

Leveraging the Manhattan Lupus Surveillance Program (MLSP), a population-based registry of cases of systemic lupus erythematosus (SLE) and related diseases, we investigated the proportion of SLE with concomitant rheumatic diseases, including Sjögren's disease (SjD), antiphospholipid syndrome (APLS), and fibromyalgia (FM), as well as the prevalence of autoantibodies in SLE by sex and race/ethnicity. Prevalent SLE cases fulfilled one of three sets of classification criteria. Additional rheumatic diseases were defined using modified criteria based on data available in the MLSP: SjD (anti-SSA/Ro positive and evidence of keratoconjunctivitis sicca and/or xerostomia), APLS (antiphospholipid antibody positive and evidence of a blood clot), and FM (diagnosis in the chart). 1,342 patients fulfilled SLE classification criteria. Of these, SjD was identified in 147 (11.0%, 95% CI 9.2-12.7%) patients with women and non-Latino Asian patients being the most highly represented. APLS was diagnosed in 119 (8.9%, 95% CI 7.3-10.5%) patients with the highest frequency in Latino patients. FM was present in 120 (8.9%, 95% CI 7.3-10.5) patients with non-Latino White and Latino patients having the highest frequency. Anti-dsDNA antibodies were most prevalent in non-Latino Asian, Black, and Latino patients while anti-Sm antibodies showed the highest proportion in non-Latino Black and Asian patients. Anti-SSA/Ro and anti-SSB/La antibodies were most prevalent in non-Latino Asian patients and least prevalent in non-Latino White patients. Men were more likely to be anti-Sm positive. Data from the MLSP revealed differences among patients classified as SLE in the prevalence of concomitant rheumatic diseases and autoantibody profiles by sex and race/ethnicity underscoring comorbidities associated with SLE.

Study on Pore Structure Characteristics of tight Sandstone Reservoirs -- Taking Chang 8 in XX block of Ordos Basin as an example

The XX block of Ordos Basin has recently achieved a major exploration breakthrough, however the reservoir is more heterogeneous and the single well productivity is more different. Based on drilling, core, analysis and testing data, the rock characteristics, physical characteristics and microscopic pore structure characteristics of the area are comprehensively analyzed. A set of reservoir classification criteria with strong applicability is established. The results show that the reservoir lithology in the study area is complex, and the types and geometric forms of reservoir space are diverse. The porosity is 0.15%~13.65%, and the permeability is) 0.001~83.5 (×10-3μm2. The distribution range of physical properties is wide, and the overall performance is low porosity and ultra-low permeability. The heterogeneity is strong, and a few large pores have an important influence on reservoir permeability. A set of reservoir classification and evaluation criteria is established. The study area mainly develops type II reservoirs. The classification and evaluation criteria can provide reference for the later exploration and development of the study area.

Korean Consensus Criteria for the Severity Classification of Alopecia Areata.

A set of criteria for severity classification is essential in alopecia areata (AA). Currently, no guidelines are universally accepted for defining AA severity. This study aimed to establish a set of consensus criteria for classifying the severity of and identifying treatment refractoriness in AA. A preliminary draft of the definition for moderate-to-severe AA was crafted based on available evidence, and members of the Korean Hair Research Society (KHRS) subsequently endorsed the recommendation through an online survey. In the first Delphi round, consensus was attained on 15 questions. After refining certain items in the second round, consensus was achieved on 23 out of 26 questions. The KHRS first defined AA severity using the severity of alopecia tool (SALT). SALT ≥50 was defined as severe, 20≤ SALT <50 as moderate, and SALT <20 as mild. Moderate AA was considered severe if it meets one or more of the following criteria: dermatology life quality index >10, presence of accompanying eyebrow or eyelash loss, positive hair loss activity, or treatment-refractory AA. These consensus criteria can help clinicians accurately diagnose AA, provide appropriate treatment, and monitor its progression.

Clinical manifestations and prognosis of giant cell arteritis: A retrospective cohort study

The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA).Methods. A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory and instrumental data, three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Associations for Rheumatology (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n=61), contrast-enhanced computed tomography (CT) (n=5), CT angiography (n=6), magnetic resonance imaging (n=4), magnetic resonance angiography (n=3) and 18F-FDG positron emission tomography/CT (n=47). Overall and recurrence-free survival were analyzed using survival tables, Kaplan – Meier method.Results. The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%) and symptoms of rheumatic polymyalgia (56.6%). Changes of temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n=158), methotrexate was used in 49 out of 158 patients, leflunomide – in 9 patients. In 45 (28.5%) out of 158 patients a stable remission was achieved as a result of GCs monotherapy, in 120 (75.9%) patients long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients – in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0–54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% confidence interval (CI): 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI: 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI: 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI: 42.0; 62.8]. 12 (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined.Conclusion. Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.

Giant cell arteritis: incidence and phenotypic distribution in Western Norway 2013-2020.

There is an increasing awareness of the spectrum of phenotypes in giant cell arteritis (GCA). However, there is sparse evidence concerning the phenotypic distribution which may be influenced by both genetic background and the environment. We established a cohort of all GCA-patients in the Bergen Health Area (Western Norway), to describe the phenotypic distribution and whether phenotypes differ with regards to incidence and clinical features. This is a retrospective cohort study including all GCA-patients in the Bergen Health Area from 2013-2020. Data were collected by reviewing patient records, and patients considered clinically likely GCA were included if they fulfilled at least one set of classification criteria. Temporal artery biopsy (TAB) and imaging results were used to classify the patients according to phenotype. The phenotype "cranial GCA" was used for patients with a positive TAB or halo sign on temporal artery ultrasound. "Non-cranial GCA" was used for patients with positive findings on FDG-PET/CT, MRI-, or CT angiography, or wall thickening indicative of vasculitis on ultrasound of axillary arteries. Patients with features of both these phenotypes were labeled "mixed." Patients that could not be classified due to negative or absent examination results were labeled "unclassifiable". 257 patients were included. The overall incidence of GCA was 20.7 per 100,000 persons aged 50 years or older. Overall, the cranial phenotype was dominant, although more than half of the patients under 60 years of age had the non-cranial phenotype. The diagnostic delay was twice as long for patients of non-cranial and mixed phenotype compared to those of cranial phenotype. Headache was the most common clinical feature (78% of patients). Characteristic clinic features occurred less frequently in patients of non-cranial phenotype compared to cranial phenotype. The overall incidence for GCA was comparable to earlier reports from this region. The cranial phenotype dominated although the non-cranial phenotype was more common in patients under 60 years of age. The diagnostic delay was longer in patients with the non-cranial versus cranial phenotype, indicating a need for examination of non-cranial arteries when suspecting GCA.

Identification and assessment of classification criteria attributes for systemic lupus erythematosus in a regional medical record data network

ObjectiveTo assess the application and utility of algorithms designed to detect features of SLE in electronic health record (EHR) data in a multisite, urban data network.MethodsUsing the Chicago Area Patient-Centered...

Single-Factor Comprehensive Reservoir Quality Classification Evaluation-Taking the Hala'alat Mountains at the Northwestern Margin of the Junggar Basin as an Example.

In the process of petroleum geology exploration and development, reservoir quality evaluation is an essential component. However, conventional reservoir quality evaluation methods are no longer able to provide accurate and comprehensive assessments for all types of reservoirs. Therefore, the comprehensive evaluation of reservoir quality using multiple single factors is of significant importance in improving the level of reservoir quality assessment and enhancing the effectiveness of oil and gas exploration techniques. Conventional reservoir quality evaluation methods can assess only the quality of individual reservoir properties, resulting in limited classification outcomes. Taking the Cretaceous formations in the southern margin of the Hala'alat Mountain in the Junggar Basin as the research object, preliminary classification criteria were established based on the principles of formation coefficient, storage coefficient, and flow unit index. Combining experimental data such as core observation, thin-section identification, pore permeability analysis, and scanning electron microscopy, a comprehensive set of reservoir quality classification and evaluation criteria were developed. Furthermore, the corresponding reservoir classification evaluation maps were generated to illustrate the spatial distribution of reservoir quality. The study reveals that the area can be classified into four types of reservoirs, namely, Class I, Class II, Class III, and Class IV, corresponding to the best reservoir, relatively good reservoir, relatively poor reservoir, and poor reservoir, respectively. Among them, the second (K1q2) and third (K1q3) members of the Cretaceous Qingshuihe Formation, as well as the first (K1h1) and third (K1h3) members of the Cretaceous Hutubi Formation, exhibit the best reservoir quality as Class II. On the other hand, the second member of the Cretaceous Hutubi Formation (K1h2) exhibits the best reservoir quality as Class III, with relatively poorer reservoir quality overall. The research findings of this study can provide an important theoretical basis for oil and gas exploration and development in the region.

Giant cell arteritis in patients with systemic sclerosis: a case series.

Giant cell arteritis (GCA) in patients with systemic sclerosis (SSc) is rare, and optimal treatment strategies for this group of patients have not been defined. We aim to describe the first case series of GCA/SSc overlap. A single-institution retrospective study was performed reviewing all patients that had diagnosis codes for both SSc and GCA between January 1, 1996, and December 31, 2020. Demographic characteristic, clinical presentation, diagnostic modality, treatment, and outcome data were abstracted. Diagnosis of both SSc and GCA by a rheumatologist was required for inclusion. Eight patients were retrospectively identified, all of which were female. Seven patients fully met both respective ACR/EULAR classification criteria sets. One patient fulfilled GCA criteria and had 8/9 points for SSc criteria plus an oesophagogram which was consistent with clinical diagnosis of SSc. Three patients had a previous history of scleroderma renal crisis (SRC) prior to glucocorticoid initiation for GCA. No episodes of SRC occurred following initiation of glucocorticoids. Three patients were treated with tocilizumab. One patient developed a diverticular perforation while on tocilizumab requiring colonic resection and colostomy, one patient discontinued tocilizumab after a medication-unrelated complication and one patient has remained on treatment and in remission. Herein we present the largest single-institution series of patients with a history of GCA and SSc, an uncommon combination. Glucocorticoid treatment for GCA did not precipitate SRC, even in those with prior history of SRC. Further investigation regarding the benefit of tocilizumab in patients with SSc and GCA is required.

Development and initial experience of a novel classification system for patients with brain stem haemorrhage.

There is no uniform classification standard for brain stem haemorrhage. On the basis of previous experience in the treatment of brainstem haemorrhage, this study explored and established a set of criteria for brainstem haemorrhage classification, risk-stratified such patients and guided the selection of treatment options so as to achieve accurate and standardized diagnosis and treatment. Thirty patients with brainstem haemorrhage from April 2019 to May 2022 were included. According to the amount and location of the brain stem bleeding, it was divided into the following types: small haemorrhage type (type 1), medium haemorrhage type (lateral type 2a, dorsal type 2b, ventral type 2c), and large haemorrhage type (type 3), and the preoperative condition and postoperative outcome within 3 months were evaluated. The included 30 patients with brainstem haemorrhage were aged 53.2 ±13.8 years old, and 80% were men. Among them, 5 patients were type 1 (16.7%), 2 patients type 2a (6.7%), 7 patients type 2b (23.3%), 5 patients type 2c (16.7%) and 11 patients type 3 (36.7%). The prognosis among these subtypes was significantly different ( p < 0.001). All type 1 patients were cured, with the highest mortality rate in type 2c patients (100%). Compared with type 2b (5.5 ±3.5 days) and type 2c (3.4 ±2.5 days), type 3 patients tend to die within fewer days (2.9 ±2.7 days). The difference in NIHSS scores was significant among surviving patients ( p < 0.001). Type 1 is the lowest at 1.8 ±2.2 points; type 3 is the highest at 35.0 ±3.5 points. Relying on the anatomical basis and treatment plan, we propose a different classification, which is conducive to quickly identifying the haemorrhage type and degree of disease, and putting forward an appropriate treatment plan, which is expected to improve the patient prognosis.

Myositis with prominent B cell aggregates may meet classification criteria for sporadic inclusion body myositis

The objective of this study was to report the clinical, serological and pathological features of patients with autoimmune myositis other than dermatomyositis, who displayed both muscle weakness on physical examination and prominent B cell aggregates on muscle pathology, defined as ≥ 30 CD20+ cells/aggregate. Specifically, the presence of a brachio-cervical inflammatory myopathies or a sporadic inclusion body myositis (sIBM) phenotype was recorded. Over a three-year period, eight patients were identified from two university neuropathology referral centers. Seven of 8 (88%) patients had an associated connective tissue disease (CTD): rheumatoid arthritis (n=3), systemic sclerosis (n=2), Sjögren's syndrome (n=1) and systemic lupus erythematosus (n=1), while one patient died on initial presentation without a complete serological and cancer investigation. A brachio-cervical phenotype, i.e. neck weakness, proximal weakness more than distal and shoulder abduction weakness greater than hip flexors, was seen in two patients (25%), while one patient had both proximal and diaphragmatic weakness. In contrast, an IBM-like clinical phenotype was seen in the last five patients (63%), who either had finger flexor weakness and/or quadriceps weakness ≤ 4 on the manual muscle testing MRC-5 scale. Although these 5 patients met at least one set of classification criteria for sIBM, an integrated clinico-sero-pathological approach argued against a diagnosis of sIBM. In summary, in a weak patient with myositis plus an associated CTD and lymphoid aggregates at muscle pathology, B cell predominant aggregates may represent a morphological biomarker against a diagnosis of sIBM.

Diagnostic accuracy of the European League against rheumatism/American College of Rheumatology-2019 versus the Systemic Lupus International Collaborating Clinics-2012 versus the ACR-1997 classification criteria in adult systemic lupus erythematosus: A systematic review and meta-analysis.

AimTo evaluate the diagnostic performance of the American College of Rheumatology (ACR)-1997, the Systemic Lupus International Collaborating Clinics (SLICC)-2012, and the European League against Rheumatism (EULAR)/ACR-2019 classification criteria in adult patients with systemic lupus erythematosus (SLE).MethodsPubMed, Embase, Web of Science and Cochrane Library databases were searched for literature comparing the three classification criteria of ACR-1997, SLICC-2012 and EULAR/ACR-2019, which took clinical diagnosis as reference. Meta-analysis was used to evaluate and compare the sensitivity, specificity and diagnostic odds ratio of ACR-1997, SLICC-2012 and EULAR/ACR-2019. To assess the early diagnosis capability of the classification criteria, subgroups of patients with disease duration < 3 years and < 1 year were selected for comparison of sensitivity and specificity based on the inclusion of the original study. The sensitivity and specificity of each item in three sets of classification criteria were evaluated. In addition, the clinical and immunological characteristics of patients who did not meet the three classification criteria were compared.ResultsNine original studies were included in the analysis, including 6404 SLE patients and 3996 controls. Results showed that the diagnostic odds ratios (95% confidence interval) of the SLICC-2012 [136.35 (114.94, 161.75)] and EULAR/ACR-2019 [187.47 (158.00, 222.42)] were higher than those of the ACR-1997 [67.53 (58.75, 77.63)]. Compared with ACR-1997[(0.86 (0.82, 0.89)], SLICC-2012[(0.96 (0.93, 0.97)] and EULAR/ACR-2019[(0.95 (0.92, 0.97)] had higher sensitivity. The specificity of the three classification criteria was similar: ACR-1997, SLICC-2012, and EULAR/ACR-2019 were 0.93 (0.89, 0.95), 0.86 (0.79, 0.91), and 0.91 (0.85, 0.95), respectively. The sensitivity of SLICC-2012 and EULAR/ACR-2019 were higher than that of ACR-1997 in early-course subgroups. Patients who did not meet ACR-1997 had more hypocomplementemia, patients who did not meet SLICC-2012 had more cutaneous lupus and photosensitivity, and patients who did not meet EULAR/ACR-2019 had more cutaneous lupus and leucopenia.ConclusionsSLICC-2012 and EULAR/ACR-2019 have better diagnostic ability than the ACR-1997, and the sensitivity of the former two criteria is also higher than that of the latter; Moreover, the SLICC-2012 and EULAR/ACR-2019 for patients in the early stages of disease performed equally excellent.

Performance of the 2017 European Alliance of Associations for Rheumatology/American College of Rheumatology Classification Criteria in Patients With Idiopathic Inflammatory Myopathy and Anti-Melanoma Differentiation-Associated Protein 5 Positivity.

This study aimed to evaluate whether the 2017 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) classification criteria for adult and juvenile idiopathic inflammatory myopathies (IIMs) could appropriately classify the diagnosis in adult patients with anti-melanoma differentiation-associated protein 5 (anti-MDA-5)-positive IIM. In addition, this study sought to determine whether a status of anti-MDA-5 positivity could be incorporated into the EULAR/ACR IIM classification criteria set and whether the recently modified criteria based on the presence of myositis-specific autoantibodies (MSAs) could be used to appropriately classify the diagnosis in patients with anti-MDA-5-positive IIM. Consecutive adult patients clinically diagnosed as having anti-MDA-5-positive IIM from 10 hospitals in Hong Kong were retrospectively recruited; patient characteristics were obtained from electronic medical records. We used a commercial line blot immunoassay to detect MSAs. We also determined a proposed set of phenotypic-serologic classification criteria specific for anti-MDA-5. In the patient cohort (n=120; 31.7% with dermatomyositis, 68.3% with clinically amyopathic dermatomyositis [CADM]), the diagnosis could be classified with the EULAR/ACR criteria in 86 patients (71.7%) and with the Bohan and Peter criteria in 49 patients (40.8%). However, when combined with criteria specifically modified for CADM, the diagnosis could be classified by the Bohan and Peter criteria in 76.7% of patients. We observed that the sensitivity of the EULAR/ACR criteria could be improved to 98.3% if anti-MDA-5 antibody-positive status was considered as one of the criteria. The MSA-based criteria had 100% sensitivity. When we applied our proposed specific phenotypic-serologic criteria for the classification of patients with anti-MDA-5 antibodies, 97.5% of patients were able to be classified as having IIM. In this cohort of patients with anti-MDA-5-positive IIM, the diagnosis could not be classified by the EULAR/ACR criteria in almost 30% of patients. We suggest incorporating anti-MDA-5 antibody positivity as a criterion into existing criteria sets or developing specific criteria for patients with anti-MDA-5-positive IIM.

Classification criteria for cervical radiculopathy: An international e-Delphi study

BackgroundEstablishing a set of uniform classification criteria (CC) for cervical radiculopathy (CR) is required to aid future recruitment of homogenous populations to clinical trials. ObjectivesTo establish expert informed consensus on CC for CR. DesignA pre-defined four round e-Delphi study in accordance with the guidance on Conducting and Reporting Delphi Studies. MethodsIndividuals with a background in physiotherapy who had authored two or more peer-reviewed publications on CR were invited to participate. The initial round asked opinions on CC for CR. Content analysis was performed on round one output and a list of discrete items were generated forming the round two survey. In rounds two to four, participants were asked to rate the level of importance of each item on a six-point Likert scale. Data were analysed descriptively using median, interquartile range and percentage agreement. Items reaching pre-defined consensus criteria were carried forward to the next round. Items remaining after the fourth round constituted expert consensus on CC for CR. ResultsTwelve participants participated with one drop out. The final round identified one inclusion CC and 12 exclusion CC. The inclusion CC that remained achieved 82% agreement and was a cluster criterion consisting of radicular pain with arm pain worse than neck pain; paraesthesia or numbness and/or weakness and/or altered reflex; MRI confirmed nerve root compression compatible with clinical findings. ConclusionsThe CC identified can be used to inform eligibility criteria for future CR trials although caution should be practiced as consensus on measurement tools requires further investigation.

Eosinophilic angiocentric fibrosis and immunoglobulin 4-related disease revisited.

Eosinophilic angiocentric fibrosis (EAF) has been postulated to lie on the spectrum of IgG4-related disease (IgG4-RD) in a study reported in 2011. However, the aetiology of EAF remains controversial, despite increasing literature reporting IgG4-RD targeted investigations in those studies. This review aims to formally evaluate the relationship between EAF and IgG4-RD using the latest 2019 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification scheme for IgG4-RD. A literature search was performed on the PubMed database for all studies describing patients diagnosed with EAF. Additionally, two EAF cases were retrospectively identified from our institution and presented. The demographics, clinical presentation, histological and serological data of each patient were analysed. A total of 20 cases were evaluated, including 18 patients from 14 articles in the English literature and two cases from our institution. Six of 20 (30%) patients with EAF met the criteria for IgG4-RD with the 2019 ACR/EULAR classification scheme. This represents the first attempt at formally evaluating the relationship between EAF and IgG4-RD using a validated set of classification criteria. Using the currently available data, a small proportion of patients with EAF met the criteria for IgG4-RD. However, various limitations of this study suggest that further efforts at disease characterization of EAF may be required.