Do Updated Vasculitis Classification Criteria Change Practice, With Anisha Dua, MD

Prior to 2022, clinicians relied on vasculitis criteria developed in 1990—frameworks that predated modern imaging, contemporary biomarker science, and much of what is now understood about disease heterogeneity. As the field advances, updated classification systems are beginning to better reflect how rheumatologists actually evaluate and categorize vasculitic syndromes in practice.¹

At the 2026 Rheumatology Winter Clinical Symposium, held in Maui, Hawaii, on February 11–14, Anisha Dua, MD, MPH, Professor at Northwestern University Feinberg School of Medicine, delivered a presentation examining updates in the field in last couple of years.² RheumatologyLive spoke with Dua during the meeting to explore whether these updates, specifically newer classification criteria, have meaningfully changed clinical practice and where gaps remain.

Dua emphasized that classification criteria are designed primarily to standardize patient populations for clinical trials, not to function as strict diagnostic tools. However, because prior criteria had not been updated in more than 30 years, the revisions represent a major step forward. The newer systems incorporate advances in pathophysiology, laboratory science, and the widespread use of imaging modalities that now play a central role in vasculitis evaluation. Rather than relying on simple checkbox-style thresholds, the updated criteria use weighted scoring, assigning greater value to features more strongly associated with specific diseases. This more nuanced approach better reflects the complexity and variability seen in clinical settings.

Still, Dua noted that the most pressing needs extend beyond classification itself. While rheumatologists are generally comfortable diagnosing clinical syndromes without rigid diagnostic criteria, unanswered questions persist regarding prognosis and therapeutic response. Identifying which patients are at higher risk for severe disease, and determining which subgroups may respond best to specific targeted therapies, remain key research priorities. Biomarker discovery and improved phenotyping may ultimately drive more personalized treatment strategies.

“Really what we want to know more about is which types of patients are going to do have have a worse prognosis or better prognosis, what type of meds are going to work better in one group versus another? And those are the questions that we have a lot of,” Dua said.

Dua’s reported disclosures include AbbVie, American College of Rheumatology (ACR), Amgen, AstraZeneca, GlaxoSmithKline (GSK), and Sanofi Genzyme.

References

1. Robson JC, Grayson PC, Ponte C, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis. Ann Rheum Dis. 2022;81(3):315-320. doi:10.1136/annrheumdis-2021-221795

2. Dua A. Evidence based medicine: Progress in the diagnosis and treatment of vasculitides. Presented at: RWCS 2026, held February 11-14 in Maui, Hawaii.