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The following is a summary of “Performance of the 2022 ACR/EULAR Classification Criteria in Comparison With the European Medicines Agency Algorithm in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis,” published in the September 2024 issue of Rheumatology by Imai et al. 

The 2022 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) criteria offer updated classification for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), leading to a comparison with the European Medicines Agency (EMA) algorithm.

Researchers conducted a retrospective study to compare the 2022 ACR/EULAR classification criteria with the EMA algorithm for ANCA-AAV.   

They reviewed all consecutive, newly diagnosed patients with AAV who visited Keio University Hospital (March 2012 and May 2022) as per the 2012 Chapel Hill Consensus Conference. According to the EMA algorithm and the 2022 ACR/EULAR criteria, patients were reclassified and statistically analyzed based on clinical characteristics.     

The results showed 114 patients with AAV, using the EMA algorithm as a reference, reclassification of the patients revealed sensitivity and specificity of the 2022 ACR/EULAR criteria of 100% and 96% for eosinophilic granulomatosis with polyangiitis, 40% and 97% for granulomatosis with polyangiitis (GPA), and 90% and 49% for microscopic polyangiitis (MPA), respectively. Approximately half of the patients classified as EMA-GPA or EMA-unclassifiable were reclassified as 2022-MPA.    

The patients were older, more likely to be positive for myeloperoxidase (MPO)-ANCA, and had interstitial lung disease (ILD) more frequently than patients with 2022-GPA or non–2022–MPA. Some patients positive for MPO-ANCA with biopsy-proven granulomatous inflammation were also reclassified from EMA-GPA to 2022-MPA. Over the mean observation period of 4.0 years, 16 patients died. The OS for each classification group differed significantly from the 2022 ACR/EULAR criteria (P=0.02) but not with the EMA algorithm (P=0.21).   

Investigators found that patients classified as EMA-GPA or EMA-unclassifiable, older individuals with MPO-ANCA and ILD were frequently reclassified as 2022-MPA. The 2022 ACR/EULAR criteria proved more effective for prognostic prediction than the EMA algorithm. 

Source: jrheum.org/content/early/2024/09/11/jrheum.2024-0335