What are the classification criteria for granulomatosis with polyangiitis (GPA)?

Updated: Oct 09, 2019
  • Author: Christopher L Tracy, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

These criteria from the American College of Rheumatology are used for enrolling patients in studies and should not be considered as diagnostic criteria. These criteria were developed before antineutrophil cytoplasmic antibody (ANCA) testing was in widespread use as a diagnostic test for GPA. The criteria are as follows:

  • Nasal or oral inflammation - Development of painful or painless oral ulcers or purulent or bloody nasal discharge

  • Abnormal chest radiography findings - Chest radiograph showing nodules, fixed infiltrates, or cavities

  • Urinary sediment - Microhematuria (> 5 red blood cells [RBCs] per high-power field [HPF]) or RBC casts in urine sediment

  • Granulomatous inflammation on biopsy - Histologic changes showing granulomatous inflammation within the wall of an artery or in the perivascular or extravascular area (artery or arteriole)

For the purposes of classification, a patient is said to have GPA if at least 2 of these 4 criteria are present. The presence of any 2 or more criteria yields a sensitivity of 88.2% and a specificity of 92%. [8]


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