Jayne David
Addenbrooke's Hospital, Renal Unit, Cambridge, UK.
Best Pract Res Clin Rheumatol. 2009 Jun;23(3):445-53. doi: 10.1016/j.berh.2009.03.001.
Early diagnosis of primary systemic vasculitis is important to allow the early commencement of therapy in order to avoid damage and poor outcomes. The heterogeneous nature of vasculitis presents a diagnostic challenge which may hinder early diagnosis. Anti-neutrophilic cytoplasmic antibody testing has been of particular benefit in defining a subgroup of small-vessel vasculitides and facilitating their earlier diagnosis. Suspicion of vasculitis is an important first step to begin a process of investigation to make or refute the diagnosis. No useful diagnostic criteria exist, but classification criteria have been developed to permit a vasculitis patient to be placed in a diagnostic subgroup. The exclusion of vasculitis 'mimics' and secondary causes of vasculitis are components of diagnosis, which otherwise relies on the recognition of a compatible clinical presentation supported by specific laboratory or imaging tests and confirmatory histology. When the diagnosis remains uncertain, observation over time, repeat investigation and a therapeutic trial may improve the probability of the diagnosis or identify an alternative disease.
原发性系统性血管炎的早期诊断对于尽早开始治疗以避免损害和不良后果至关重要。血管炎的异质性带来了诊断挑战，可能会阻碍早期诊断。抗中性粒细胞胞浆抗体检测在定义小血管血管炎亚组并促进其早期诊断方面具有特别的益处。怀疑血管炎是开始调查过程以做出或排除诊断的重要第一步。目前尚无有用的诊断标准，但已制定分类标准以便将血管炎患者归入诊断亚组。排除血管炎的“模仿者”和血管炎的继发原因是诊断的组成部分，否则诊断依赖于通过特定实验室或影像学检查及确诊组织学支持的相容临床表现的识别。当诊断仍不确定时，随时间观察、重复检查和治疗试验可能会提高诊断的可能性或识别出另一种疾病。
