Current guidelines are inadequate to incorporate vasculitic syndromes involving skin.
Clinical Photography, Central Manchester University Hospitals NHS Foundation Trust, UK / Science Source
CHICAGO—Warren Piette, MD, professor of dermatology at Rush University Medical Center, Chicago, updated rheumatologists on the topic of cutaneous vasculitis at the ACR’s State-of-the-Art Clinical Symposium in April. He began by explaining that the current vasculitis criteria developed by the ACR in 1990 and the Chapel Hill Consensus Conference (CHCC) in 1994 are inadequate to incorporate vasculitic syndromes involving skin. This deficiency has led an international group to propose revised criteria that will soon be submitted to Arthritis & Rheumatology.
Dr. Piette focused his talk on immune complex vasculitis and anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis and the purpura that are key to their diagnosis. He explained that purpura can be primary or secondary, and distinguishing the two clinically is more art than science. He emphasized the importance of lesional morphology in sorting purpura pathophysiology into simple hemorrhage, inflammatory hemorrhage or microvascular occlusion, and he also disputed a few dogmas.
Primary Palpable Purpura Are Not Specific for Vasculitis
Primary palpable purpura are not specific for vasculitis. Moreover, explained Dr. Piette, vasculitis is not always palpable or purpuric. He then showed a series of slides of purpura and talked the audience through their diagnoses.