Evaluation of revised classification criteria for giant cell arteritis and its clinical phenotypes

Abstract

Background Giant cell arteritis (GCA) is a systemic vasculitis of the elderly, viewed by many as a disease with multiple and overlapping clinical phenotypes. Retrospective studies have shown differences in clinical presentation between these phenotypes. To reflect the heterogeneity of GCA, and novel diagnostic methods, new classification criteria have been proposed. Methods This is a retrospective study of newly diagnosed patients with GCA at the outpatient rheumatology clinics at Skåne University Hospital (Malmö and Lund) between 2012 and 2018. All patients were evaluated using two sets of classification criteria—the American College of Rheumatology (ACR) classification criteria from 1990, and a proposed revision of these criteria requiring objective findings (positive biopsy or imaging) for classification. Patients were further classified as one of four widely used clinical phenotypes. Results A total of 183 patients with a new diagnosis of GCA were identified. The diagnosis was confirmed by 1–2 experienced rheumatologists in 116 of these patients at review of medical records. The ACR criteria were more sensitive than the revised criteria (93.1% vs 72.4%), while the revised criteria had higher specificity (94.0% vs 28.4%). The revised criteria tended to have higher sensitivity in the phenotype with constitutional symptoms compared to cranial GCA (p = 0.08). Conclusion The specificity of the ACR classification criteria for GCA can be improved by using revised criteria requiring objective findings of vasculitis. In addition, the wider symptoms covered by the revised criteria may improve classification of patients with a phenotype characterized by constitutional symptoms.

Comparison of classification criteria for giant cell arteritis

“…оценивали критерии ACR 1990 г. и пересмотренные критерии ACR 2016 г. [18]. Чувствительность и специфичность первых составили 93,1% и 28,4%, соответственно, вторых -72,4% и 94,0%.…”

“…Биопсия височной артерии была выполнена у 7 пациентов, из них только у 3 пациентов был подтвержден диагноз ГКА. Изменения височной артерии при ультразвуковом исследовании были выявлены у 24 (64,9%) из 37 пациентов с ГКА, накопление 18 F-фтордезоксиглюкозы в стенке аорты и/или ее крупных ветвей -у 43 (91,5%) из 47, изменения ветвей дуги аорты при МР-или контрастной ангиографии -у 13 (81,3%) из 16. У 9 пациентов контрольной группы, которым проводилась ПЭТ, накопление 18…”

Global epidemiology of vasculitis

“…In some regions, vascular imaging (particularly ultrasonography of temporal arteries) is replacing traditional temporal artery biopsy (TAB) for GCA diagnosis, but vascular imaging is not routinely undertaken in all regions and centres. The 1990 ACR criteria for GCA do not include vascular imaging 15 , although the performance of the criteria can be improved by including imaging 33 . New joint ACR–EULAR criteria are currently being developed that will address this issue 7 .…”

Hortono Liga: Patogenezė, Klinikiniai Požymiai Ir Gydymas

“…Gigantinių ląstelių arterito diagnozė pagrįsta klinikiniais požymiais ir smilkininių arterijų biopsija, kurioje stebimi vaskulito požymiai [2]. JAV reumatologų kolegija yra pa-tvirtinusi 5 diagnostinius kriterijus, kuriais remiantis diagnozuojama Hortono liga: simptomų pradžia ≥ 50 metų amžius, naujai atsiradę galvos skausmai, temporalinės arterijos pokyčiai, ENG ≥ 50 mm/h, pokyčiai smilkininės arterijos biopsijoje [10]. Rekomenduojama paimti didesnį smilkininės arterijos biopsijos mėginį dėl dažnai pasitaikančių neuždegiminių arterijos plotų, kurie gali sąlygoti klaidingai neigiamą diagnozę [11].…”