Are the 1990 American College of Rheumatology vasculitis classification criteria still valid?

Seeliger, Benjamin; Sznajd, J; Robson, Joanna; Judge, Andrew; Craven, Anthea; Grayson, Peter C.; Suppiah, Ravi; Watts, Richard A.; Merkel, Peter A.; Luqmani, Raashid

doi:10.1093/rheumatology/kex075

Cited by 94 publications

(57 citation statements)

References 16 publications

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“…Diagnosing GCA can be challenging and requires a full history for clinical features, thorough examination and a combination of investigations. There are classification criteria, but no universally accepted diagnostic criteria [30]. Choosing the optimal investigations depends on which area of the body the disease is suspected to be present because one third of LV-GCA patients have no ultrasonographic evidence of cranial/temporal arteritis [19], and more than half of LV-GCA patients have a normal temporal artery biopsy [31].…”

Section: What Is the Best Way To Diagnose Gca?mentioning

confidence: 99%

European Headache Federation recommendations for neurologists managing giant cell arteritis

et al. 2020

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Background and aim: Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA. Methods: The working group identified relevant questions, performed systematic literature review and assessed the quality of available evidence, and wrote recommendations. Where there was not a high level of evidence, the multidisciplinary (neurology, ophthalmology and rheumatology) group recommended best practice based on their clinical experience. Results: Across Europe, fast track pathways and the utility of advanced imaging techniques are helping to reduce diagnostic delay and uncertainty, with improved clinical outcomes for patients. GCA is treated with high dose glucocorticoids (GC) as a first line agent however long-term GC toxicity is one of the key concerns for clinicians and patients. The first phase 2 and phase 3 randomised controlled trials of Tocilizumab, an IL-6 receptor antagonist, have been published. It is now been approved as the first ever licensed drug to be used in GCA. Conclusion: The present article will outline recent advances made in the diagnosis and management of GCA.

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Section: What Is the Best Way To Diagnose Gca?mentioning

confidence: 99%

European Headache Federation recommendations for neurologists managing giant cell arteritis

et al. 2020

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“…The American College of Rheumatology classification criteria for GCA, published in 1990, requires three or more of the following five criteria [1]: age 50 years and older [2], new onset of localized headache [3], temporal artery tenderness on palpation or decreased pulsation [4], an abnormal temporal artery biopsy, and [5] an erythrocyte sedimentation rate (ESR) of 50 mm/h or more ( Table 1) [7]. These criteria are designed to be classificatory and not diagnostic, with sensitivity and specificity of 81.1% and 64.2%, respectively [8]. In the last years, new imaging techniques have emerged and can be helpful tools on diagnosis and disease activity assessment.…”

Section: Diagnosismentioning

confidence: 99%

Giant Cell Arteritis: Current Advances in Pathogenesis and Treatment

Dagostin¹,

Pereira²

2020

Vascular Biology - Selection of Mechanisms and Clinical Applications

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Giant cell arteritis (GCA) is the most common vasculitis in adults, with the incidence increasing with the advancing age. The aorta and its branches, especially the carotid extracranial branches, are the classic targets of inflammation in GCA. Visual loss, upper limb ischemia, and stroke are complications described. Suspicion of GCA is a medical emergency, and patients need to be quickly diagnosed/treated to prevent irreversible damage. Headache is the most common symptom, and a newonset headache in older adults should always raise the suspicion of GCA. Patients may also present with scalp tenderness or tongue/jaw pain. GCA is often found to be the cause of an obscure-origin fever in older patients. A positive temporal artery biopsy is considered the gold standard for the diagnosis, but imaging techniques enable the assessment of cranial and extracranial arteries and the aorta. Ultrasound of temporal arteries is recommended and noncompressible "halo" sign is the typical finding. PET, MRI, or CT may be useful for the detection of the disease in the aorta and other vessels. The treatment must be started promptly with prednisone 1 mg/ kg/day. When visual symptoms/unilateral visual loss is present, methylprednisolone pulse is recommended. Methotrexate, leflunomide and tocilizumab may be effective and well-tolerated glucocorticoid-sparing agents in GCA. Cardiovascular diseases are the leading causes of death in patients.

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“…The sensitivities of these criteria ranged from 71.0% to 95.3% and the specificities ranged from 78.7% to 99.7%. Analysis of the performance of the ACR 1990 criteria in the Diagnostic and Classification Criteria of Vasculitis study (DCVAS) dataset suggests there has also been a decline in the sensitivity of the 1990 ACR classification criteria for vasculitis, particularly for the q 7 ANCA associated vasculitides (AAV) …”

Section: American College Of Rheumatology (1990) Criteriamentioning

confidence: 99%

Evolving concepts in classification of systemic vasculitis: where are we and what is the way forward?

Watts

2018

Int J of Rheum Dis

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The classification of the systemic vasculitides has been controversial for several decades. The Chapel Hill consensus Conference definitions originally developed in 1994, but revised and extended in 2012 are now widely accepted. The American College of Rheumatology (ACR) criteria were first published in 1990, are now generally accepted to be out of date and new criteria are needed. More recently the classical division of the ANCA vasculitides using clinical phenotype has come under scrutiny with evidence from epidemiological, genetic and outcome studies that perhaps these conditions should be classified on the basis of ANCA specificity into PR3-ANCA positive and MPO-ANCA positive groups. The traditional distinction between giant cell arteritis and Takayasu arteritis has been questioned and some recent studies of GCA have included patients with only extra-cranial disease. The Diagnostic and Classification Criteria of Vasculitis study (DCVAS) will provide new validated classification criteria for the systemic vasculitides.

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Are the 1990 American College of Rheumatology vasculitis classification criteria still valid?

Abstract: Since publication of the ACR criteria for vasculitis, the sensitivity for each type of vasculitis, except GCA, has diminished, although the specificities have remained high, highlighting the need for updated classification criteria.

Cited by 94 publications

References 16 publications

European Headache Federation recommendations for neurologists managing giant cell arteritis

European Headache Federation recommendations for neurologists managing giant cell arteritis

Giant Cell Arteritis: Current Advances in Pathogenesis and Treatment

Evolving concepts in classification of systemic vasculitis: where are we and what is the way forward?

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