Differentiating Churg-Strauss syndrome from other diseases: Difference between revisions
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|- | |- | ||
|Cytoplasmic ANCA (cANCA) | |Cytoplasmic ANCA (cANCA) | ||
| | |≠ | ||
|90% positive | |90% positive | ||
| | |≠ | ||
|- | |- | ||
|Perinuclear ANCA (pANCA) | |Perinuclear ANCA (pANCA) | ||
|30 to 40% positive | |30 to 40% positive | ||
| | |≠ | ||
|60 to 80% positive | |60 to 80% positive | ||
|- | |- | ||
|Myeloperoxidase antigen | |Myeloperoxidase antigen | ||
| | |40% sensitivity | ||
| | |10% sensitivity | ||
| | |30% sensitivity | ||
|- | |- | ||
|Proteinase 3 antigen | |Proteinase 3 antigen | ||
| | |<5% sensitivity | ||
| | |70-80% sensitivity | ||
| | |60% sensitivity | ||
|} | |} | ||
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In order to make a diagnosis of Eosinophilic granulomatosis with polyangiitis the following criteria must be present: | In order to make a diagnosis of Eosinophilic granulomatosis with polyangiitis the following criteria must be present: | ||
According to the '''American College of Rheumatology classification criteria''' <ref name="pmid2202307">{{cite journal| author=Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP et al.| title=The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). | journal=Arthritis Rheum | year= 1990 | volume= 33 | issue= 8 | pages= 1094-100 | pmid=2202307 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2202307 }}</ref> | According to the '''American College of Rheumatology classification criteria''' <ref name="pmid2202307">{{cite journal| author=Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP et al.| title=The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). | journal=Arthritis Rheum | year= 1990 | volume= 33 | issue= 8 | pages= 1094-100 | pmid=2202307 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2202307 }}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
|Asthma | |Asthma | ||
| Line 75: | Line 74: | ||
|} | |} | ||
According to Lanham diagnostic criteria: | According to '''Lanham diagnostic criteria''' <ref name="pmid6366453">{{cite journal| author=Lanham JG, Elkon KB, Pusey CD, Hughes GR| title=Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. | journal=Medicine (Baltimore) | year= 1984 | volume= 63 | issue= 2 | pages= 65-81 | pmid=6366453 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6366453 }}</ref> | ||
{| class="wikitable" | |||
|Asthma | |||
Eosinophilia peak of >1.5x10<sup>9</sup> cell/L or >10% of the total WBC | |||
Systemic vasculitis, two or greater extra pulmonary sites | |||
| | |||
All 3 criteria’s need to be present | |||
|} | |||
==References== | ==References== | ||
Revision as of 17:20, 10 March 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2]Associate Editor(s)-in-Chief: Krzysztof Wierzbicki M.D. [3]
Overview
Eosinophilic granulomatosis with polyangiits must be differentiated from other diseases that can cause purpura, alveolar hemorrhage, fever, arthralgia, myalgia, necrotizing extra-capillary glomerulonephritis, such as Granulomatosis with polyangiitis and Microscopic polyangiitis.[1]
Differentiating Eosinophilic granulomatosis with polyangiitis from other Diseases
Eosinophilic granulomatosis with polyangiitis must be differentiated from other diseases that cause purpura, alveolar hemorrhage, necrotizing extra-capillary glomerulonephritis, such as Granulomatosis with polyangiitis and Microscopic polyangiitis.[1]
| Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis serological findings | |||
|---|---|---|---|
| Eosinophilic granulomatosis with polyangiitis | Granulomatosis with polyangiitis | Microscopic polyangiitis | |
| Cytoplasmic ANCA (cANCA) | ≠ | 90% positive | ≠ |
| Perinuclear ANCA (pANCA) | 30 to 40% positive | ≠ | 60 to 80% positive |
| Myeloperoxidase antigen | 40% sensitivity | 10% sensitivity | 30% sensitivity |
| Proteinase 3 antigen | <5% sensitivity | 70-80% sensitivity | 60% sensitivity |
Differentiating Eosinophilic granulomatosis with polyangiitis from other Diseases
Eosinophilic granulomatosis with polyangiitis must be differentiated from other diseases that cause pulmonary eosinophilia and perinuclear anti-neutrophil cytoplasmic antibodies (ANCA) such as:[2]
Pulmonary eosinophilia
- Parasitic infections
- Drugs
- Allergic bronchopulmonary aspergillosis
Perinuclear ANCA
- Cystic Fibrosis
- Bronchogenic carcinoma
- Inflammatory bowel disease
- Sclerosing cholangitis
- Myeloproliferative disorders
- Systemic lupus erythematosis
- Rheumatoid arthritis
Diagnosis of Eosinophilic granulomatosis with polyangiitis
In order to make a diagnosis of Eosinophilic granulomatosis with polyangiitis the following criteria must be present:
According to the American College of Rheumatology classification criteria [3]
| Asthma
Eosinophilia Polyneuropathy or Mononeuropathy Non fixed pulmonary infiltrates Paranasal sinus that is abnormal Eosinophil's that are extravascular |
Patients must express 4 out the 6 criteria to be diagnosed with eosinophilic granulomatosis with polyangiitis. |
According to Lanham diagnostic criteria [4]
| Asthma
Eosinophilia peak of >1.5x109 cell/L or >10% of the total WBC Systemic vasculitis, two or greater extra pulmonary sites |
All 3 criteria’s need to be present |
References
- ↑ 1.0 1.1 Pagnoux C (2016). "Updates in ANCA-associated vasculitis". Eur J Rheumatol. 3 (3): 122–133. doi:10.5152/eurjrheum.2015.0043. PMID 27733943.
- ↑ Conron M, Beynon HL (2000). "Churg-Strauss syndrome". Thorax. 55 (10): 870–7. PMC 1745623. PMID 10992542.
- ↑ Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP; et al. (1990). "The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis)". Arthritis Rheum. 33 (8): 1094–100. PMID 2202307.
- ↑ Lanham JG, Elkon KB, Pusey CD, Hughes GR (1984). "Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome". Medicine (Baltimore). 63 (2): 65–81. PMID 6366453.