EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups: a methodology report

RMD Open - Tập 3 Số 2 - Trang e000507 - 2017
Matteo Bottai1, Anna Tjärnlund2, Giola Santoni3, Victoria P. Werth4, Clarissa Pilkington5, Marjolein Visser6, Lars Alfredsson7, Anthony A. Amato8, Richard J. Barohn9, Matthew H. Liang10, Jasvinder A. Singh11, Rohit Aggarwal12, Snjólaug Arnardottir13, Hector Chinoy14, Robert G. Cooper15, Katalin Dankó16, Mazen M. Dimachkie9, Brian M. Feldman17, Ignacio García‐De La Torre18, Patrick Gordon19, Taichi Hayashi20, James D. Katz21, Hitoshi Kohsaka22, Peter A. Lachenbruch23, Bianca Lang24, Yuhui Li25, Chester V. Oddis12, Marzena Olesinka26, Ann M. Reed27, Lidia Rutkowska‐Sak28, Helga Sanner29, Albert Selva-O’Callaghan30, Yeong Wook Song31, Jiří Vencovský32, Steven R. Ytterberg33, Frederick W. Miller34, Lisa G. Rider34, Ingrid E. Lundberg2
1Unit of Biostatistics, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
2Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
3Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
4Department of Dermatology, Philadelphia VAMC and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
5Department of Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UK
6Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
7Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
8Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
9Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
10Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, and Section of Rheumatology, Boston VA Healthcare System, Boston, Massachusetts, USA
11University of Alabama at Birmingham (UAB) and Birmingham VA Medical, Birmingham, Alabama, USA
12Division of Rheumatology and Clinical Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
13Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
14National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
15MRC/ARUK Institute of Ageing and Chronic Disease, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
16Division of Immunology, 3rd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
17Department of Pediatrics, Division of Rheumatology, University of Toronto and The Hospital for Sick Children, Toronto, Canada
18Department of Immunology and Rheumatology, Hospital General de Occidente, Secretaría de Salud, and University of Guadalajara, Guadalajara, Mexico
19Department of Rheumatology, King’s College Hospital NHS Foundation Trust, London, UK
20Clinical Immunology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
21US Department of Health and Human Services, National Institutes of Health, Bethesda, Maryland, USA
22Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
23Department of Public Health, Oregon State University, Corvallis, Oregon, USA
24Department of Pediatrics, Division of Rheumatology, IWK Health Centre and Dalhousie University, Halifax, Canada
25Department of Rheumatology and Immunology, People’s Hospital of Beijing University, Beijing, China
26Connective Tissue Diseases Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
27Department of Pediatrics, Duke University, Durham, North Carolina, USA
28Paediatric Clinic of Rheumatology, Institute of Rheumatology, Warsaw, Poland
29Section of Rheumatology, Oslo University Hospital–Rikshospitalet, Oslo, Norway
30Vall d’Hebron General Hospital, Barcelona, Spain
31Department of Internal Medicine, Medical Research Center, Clinical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
32Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
33Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
34Environmental Autoimmunity Group, US Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA

Tóm tắt

ObjectiveTo describe the methodology used to develop new classification criteria for adult and juvenile idiopathic inflammatory myopathies (IIMs) and their major subgroups.MethodsAn international, multidisciplinary group of myositis experts produced a set of 93 potentially relevant variables to be tested for inclusion in the criteria. Rheumatology, dermatology, neurology and paediatric clinics worldwide collected data on 976 IIM cases (74% adults, 26% children) and 624 non-IIM comparator cases with mimicking conditions (82% adults, 18% children). The participating clinicians classified each case as IIM or non-IIM. Generally, the classification of any given patient was based on few variables, leaving remaining variables unmeasured. We investigated the strength of the association between all variables and between these and the disease status as determined by the physician. We considered three approaches: (1) a probability-score approach, (2) a sum-of-items approach criteria and (3) a classification-tree approach.ResultsThe approaches yielded several candidate models that were scrutinised with respect to statistical performance and clinical relevance. The probability-score approach showed superior statistical performance and clinical practicability and was therefore preferred over the others. We developed a classification tree for subclassification of patients with IIM. A calculator for electronic devices, such as computers and smartphones, facilitates the use of the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria.ConclusionsThe new EULAR/ACR classification criteria provide a patient’s probability of having IIM for use in clinical and research settings. The probability is based on a score obtained by summing the weights associated with a set of criteria items.

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Lundberg IE , Tjärnlund A , Bottai M , et al . EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis and Arthritis Rheum. Accepted for publication.

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