Bayesian Classification of Vasculitis: A Simulation Study

Abstract:

New classification criteria for vasculitic disorders have recently been proposed by the American College of Rheumatology. These classification criteria have limitations inherent to the method employed in their development. We propose a different approach to the quantitative analysis of the manifestations of vasculitis, which may improve the precision of classification criteria in this domain. Bayesian classifiers were developed for six vasculitides using literature-derived quantitative descriptions of these syndromes. These clinical data were also used in computer programs designed to generate simulations of vasculitis and control cases. The performance of Bayesian classifiers of vasculitis was then compared to that of the American College of Rheumatology criteria, using series of computer-simulated vasculitis cases. Bayesian classifiers identified simulated vasculitis cases with greater accuracy than those of the corresponding American College of Rheumatology 1990 vasculitis criteria in all six diseases studied. As predicted by theoretical considerations, Bayesian classifiers have the potential to identify vasculitis cases more accurately than the proposed American College of Rheumatology 1990 criteria.

Keywords:

Vasculitis - Disease Classification - Decision Support - Bayes Theorem - Computer Simulation

• References

• 1 Cohen AS, Reynolds WE, Frankin EC. et al. Preliminary criteria for the classification of systemic lupus erythematosus. Bull Rheum Dis 1971; 21: 643-8.
• 2 Tan EM, Cohen AS, Fries JF. et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271-7.
• 3 Arnett FC, Edworthy SM, Bloch DA. et al. The 1987 American Rheumatism Association revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-24.
• 4 Subcommittee for scleroderma criteria of the American Rheumatism Association diagnostic and therapeutic criteria committee: Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 1980; 23: 581-90.
• 5 Lightfoot RW, Michel BA, Bloch DA. et al. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 1990; 33: 1088-93.
• 6 Masi AT, Hunder GG, Lie JT. et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (Allergic granulomatosis and angiitis). Arthritis Rheum 1990; 33: 1094-100.
• 7 Leavitt RY, Fauci AS, Bloch DA. et al. The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 1990; 33: 1101-7.
• 8 Calabrese LH, Michel BA, Bloch DA. et al. The American College of Rheumatology 1990 criteria for the classification of hypersensitivity vasculitis. Arthritis Rheum 1990; 33: 1108-13.
• 9 Mills JA, Michel BA, Bloch DA. et al. The American College of Rheumatology 1990 critria for the classification of Henoch-Schonlein purpura. Arthritis Rheum 1990; 33: 1114-21.
• 10 Hunder GG, Bloch DA, Michel BA. et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990; 33: 1122-28.
• 11 Arend WP, Michel BA, Bloch DA. et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990; 33: 1129-34.
• 12 Clough JD, Elrazak M, Calabrese LH, Valenzuela R, Braun WE. Weighted criteria and test selection in the diagnosis of systemic lupus erythematosus (abstract). Clin Res 1982; 30: 804A.
• 13 Tan PLJ, Borman GB, Wigley RD. Testing clinical criteria for systemic lupus erythematosus in other connective tissue disorders. Rheumatol Int 1981; 1: 147-9.
• 14 Manu P. Receiver operating characteristic curves of the revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1983; 26: 1054-5.
• 15 Manu P. Serial probability analysis of the 1982 revised criteria for the classification of systemic lupus erythematosus. N Engl J Med 1983; 309: 1460.
• 16 Clough JD, Elrazak M, Calabrese LH. et al. Weighted criteria for the diagnosis of systemic lupus erythematosus. Arch Int Med 1984; 144: 281-5.
• 17 Spiegelhalter DJ. Statistical methodology for evaluating gastrointestinal symptoms. Clin Gastroenterology 1985; 14: 489-515.
• 18 Chard T. Qualitative probability versus quantitative probability in clinical diagnosis: a study using a computer simulation. Med Decis Making 1991; 11: 38-41.
• 19 Wasson JR, Sox HC, Neff RK, Goldman L. Clinical prediction rules. Applications and methodological standards. N Engl J Med 1985; 313: 793-9.
• 20 Swets JA, Pickett RM, Whitehead SF. et al. Assessment of diagnostic technologies. Science 1979; 205: 753-9.
• 21 Fries JF. Disease criteria for systemic lupus erythematosus (editorial). Arch Int Med 1984; 144: 252-3.
• 22 Edworthy SM, Zatarain E, McShane DJ, Bloch DA. Analysis of the 1982 ARA lupus criteria data set by recursive partitioning methodology: new insights into the relative merit of individual criteria. J Rheumatol 1988; 15: 1493-8.
• 23 Bernelot Moens HJ, Van der Korst JK. Development and validation of a computer program using Bayes’ theorem to support diagnosis of rheumatic disorders. Ann Rheum Dis 1992; 51: 266-71.
• 24 Bernelot Moens HJ, Van der Korst JK. Comparison of rheumatological diagnoses by a Bayesian program and by physicians. Meth Inform Med 1991; 30: 187-93.
• 25 Fagan TJ. Nomogram for Bayes’s theorem (letter). N Engl J Med 1975; 293: 257.
• 26 Rembold CM, Watson D. Post-test probability calculation by weights. Ann Intern Med 1988; 108: 115-20.