BackgroundExternal validation of the 2022 ACR/EULAR GPA, EGPA and MPA Classification Criteria is recommended by the DCVAS study group [1-3].ObjectivesTurkish Vasculitis Study (TRVaS) prospective cohort is an electronic database including 15 centres from all over Turkey. We aimed to test performance of the recent criteria sets in TRVaS cohort.MethodsPatients diagnosed according to physicians’ decisions have been recruited prospectively in TRVaS (in total 3730 patients by January 2023). 2022 ACR/EULAR and 1990 ACR Classification Criteria sets were applied to all of the patients with AAV [GPA (n=533), EGPA (n=112), MPA (n=105), and unclassified AAV (n=70)], poliarteritis nodosa (PAN, n=47) and IgA Vasculitis (n=76). Performances were analysed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.ResultsFor the patients with GPA, 2022 criteria had higher sensitivity and specifity compared to 1990’s (83.6% vs. 71.0% and 95.6% vs. 88.6%, respectively in Table). A significant increase was observed in sensitivity for 2022 criteria for patients with EGPA (86.4% vs.59.1%) with no change in specificity. Sensitivity and specificity of 2022 MPA criteria was calculated as 83.8% and 89.8%, respectively. Using the 2022 criteria to the patients with unclassified AAV, led to classify seven (10.0%) patients as GPA and 29 (41.0%) patients as MPA. Of 47 patients with PAN, one patient fulfilled 1990 ACR and another fulfilled 2022 GPA criteria. Others were not classified as EGPA or MPA. None of the patients with IgA vasculitis fulfilled 2022 AAV criteria. Of 533 patients with GPA, 1.5% fulfilled both 2022 GPA and MPA criteria and 7.7% fulfilled only MPA criteria (Figure). In each clinically diagnosed AAVs, around 10% of patients were not classified by any 2022 criteria.ConclusionUsing 2022 ACR/EULAR Classification Criteria, improved sensitivity and specifity for GPA and sensitivity for EGPA were observed. Additionally, half of the unclassified AAV patients could be classified as either GPA or MPA. These criteria functioned well for the discrimination of patients with AAV from other small/medium vessel vasculitides such as PAN and IgA vasculitis. In total, over 80% of the patients with AAV were accordingly classified in paralel to the clinical diagnosis in each GPA/EGPA/MPA.References[1]Robson, J.C.et al s.Ann Rheum Dis2022,81, 315-320.[2]Grayson, P.C. et al.Ann Rheum Dis2022,81, 309-314.[3]Suppiah, R.Ann Rheum Dis2022,81, 321-326.Figure.Classification of clinically diagnosed GPA/EGPA/MPA patients using 2022 ACR/EULAR criteria setsTable.Performance of 1990 ACR and 2022 ACR/EULAR criteriaGPANon-GPA AAVEGPANon-EGPA AAVMPANon-MPA AAVPAN + IgAV1990 ACR Wegener criteriaSn/Sp71/88.671/84----71/99.2PPV/NPV89.3/69.689.6/60----99.7/44Accuracy78.675.4----76.32022 ACR/EULAR GPASn/Sp83.6/95.683.6/94.1----83.6/99.2PPV/NPV96.3/81.296.5/74.5----99.8/58.2Accuracy88.787.1----86.51990 Churg-Strauss criteriaSn/Sp--59.1/10059.1/100--59.1/100PPV/NPV--100/94.6100/93.7--100/73.1Accuracy--9594.2--80.62022 ACR/EULAR EGPASn/Sp--86.4/99.886.4/99.8--86.4/100PPV/NPV--98.9/98.198.9/97.81--100/89.1Accuracy--98.297.9--93.52022 ACR/EULAR MPASn/Sp----83.8/89.883.8/87.983.8/100PPV/NPV----52.1/97.752.1/97.2100/87.8Accuracy----89.187.492.5Acknowledgements:NIL.Disclosure of InterestsNone Declared.
BackgroundTuberculin skin test (PPD) or interferon gamma release assays (IGRAs) are used to detect latent tuberculosis infection. Induration of 15 mm or more is considered positive in any person whereas this cut-off is ≥5 mm for immunosuppressed individuals such as Rheumatoid arthritis. Since IGRAs are dependent on normal T-cell function, it may result in false-negatives for among RA patients due to disease itself and immunosuppressive drugs.ObjectivesWe aimed to compare IGRA results of RA patients using high dose DMARDS vs. not using any of them.MethodsTotally 534 RA patients among Hacettepe University Rheumatology Biologic Registry Database (HURBIO) database was enrolled into this study. QFT-Plus test of patients with rheumatoid arthritis (RA) between January 2018 and March 2021 during work up before biologic/targeted therapy were analysed, retrospectively. The patient group was divided into two according to the drugs have been using at the time of IGRA test. Patients using methotrexate ≥ 10 mg or leflunomide (any dose) or steroids (≥7.5 mg prednisolone) or any combination thereof were classified as the “High Dose” group. The other group consisted of patients who did not take these drug doses. Demographic characteristics, comorbidities, drugs and doses used, and hemogram, sedimentation, and CRP values of the patients were recorded. QuantiFERON test was recorded as positive, negative, indeterminate.Results353(66.1%) RA patients were in the high dose patient group and also 287(81.3%) of these patients were female, the median age was 55 years (min:19- max:82). The high dose group was older than the other group. When the two groups were compared, no statistically significant difference was found between comorbidity, and smoking (Table 1). While QFT positivity was detected in 37 (10.5%) patients in the high-dose group, it was found to be positive in 37 (20.4%) patients in the other group (p<0.001). However, there was no significant difference regarding acute phase reactants, hemogram including lymphocyte counts and IFN-gamma levels in the tubes between these two groups.Table 1.Comparison of RA patients’ groups using high-dose immunosuppressives and not using any of themHigh Dose Methotrexate or Leflunomide or Steroid (+), (%)66.1High Dose Methotrexate or Leflunomide or Steroid (-), (%)33.9P ValueFemale81.375.10.09Age, med (min-max)55 (19-82)52 (19-81)0.01Diabetes Mellitus1110.50.84Hypertension30.624.90.16Chronic Renal Failure0.300.66Chronic Obstructive Pulmonary Disease4.23.30.59Coronary Artery Disease3.76.10.20History of malignancy0.81.70.40SmokingNever4952.50.19Ever24.127.6Quit26.318.8Leukocyte,*103/mlMedian (min-max)7.6 (2.8-28.8)7.9 (3.5 – 20.8)0.26Neutrophil,*103/ml4.8 (0.2-23.0)5.0 (1.5-19.1)0.18Lymphocyte,*103/ml1.9 (0.4-5.9)1.8 (0.5-5.3)0.67Thrombocyte,*103/ml285 (117-669)285.5 (60-724)0.79Hemoglobine,g/dL12.8 (7.7-17.9)12.8 (9.3-16.6)0.41Sedimentation,mm/saat30 (2-294)28 (2-104)0.27C Reactive Protein,mg/dl1.1 (0.1-62.8)1.1 (0-20.7)0.96QuantiFERON-TB Gold-Plus (QFT-Plus)10.520.40.00Nil med (min-max)0.07 (0-2.7)0.05 (0-0.85)0.48QFT-Plus TB-1 med (min-max)1 (0->10)0.99 (0->10)0.25QFT-Plus TB-2 med (min-max)1 (0->10)1.1 (0->10)0.42Mitogen med (min-max)10 (0->10)9.5 (0->10)0.27MethotrexateNot Taking31.433.7Less than 10 mg44.266.310 mg and more24.40LeflunomideNot Taking25.8100Taking74.20HydroxychloroquineNot Taking25.240.9Taking74.859.1SulfasalazineNot Taking62.661.9Taking37.438.1SteroidsNot Taking4.219.9Less than 7.5 mg66.380.17.5 mg and more29.50ConclusionOur results confirmed a significantly lower QFT-Plus positivity in patients with RA taking methotrexate ≥ 10 mg or leflunomide (any dose) or steroids (≥7.5 mg prednisolone). Physicians should be careful in interpretation of QFT-Plus in patients with rheumatoid arthritis. Further analysis including flow cytometry analysis is required to better identifying cut-offs for immunosuppressive individuals and patients with inflammatory rheumatic diseases.Disclosure of InterestsNone declared
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