Influence of the EULAR recommendations for the use of imaging in large vessel vasculitis in the diagnosis of giant cell arteritis: results of the ARTESER register

Abstract

ObjectiveThe main study objective was to determine how giant cell arteritis (GCA) is diagnosed in our clinical practice and whether the EULAR recommendations have influenced the diagnostic procedures used.MethodsARTEritis of the Rheumatology Spanish Society -Sociedad Española de Reumatología (ARTESER) is a multicentre observational retrospective study conducted in 26 hospitals with support from the Spanish Society of Rheumatology. All patients diagnosed with GCA between 1 June 2013 and 29 March 2019 were included. The gold standard for the diagnosis of GCA was the judgement of the physician in charge, according to clinical criteria, supported by data available from laboratory tests, imaging studies (ultrasound, positron emission tomography (PET) and MRI/CT angiography) and temporal artery biopsy (TAB) when available.ResultsWe included 1675 patients with GCA (mean age±SD (76.9±8.1) years, 1178 women (70.3%)). Of these, 776 patients had a positive TAB (46.3%), 503 (30.0%) positive ultrasound, 245 positive PET (14.6%) and 64 positive MRI/CT angiography (3.8%). These percentages changed substantially over the study. From 2013 to 2019, the use of ultrasound in diagnosis grew from 25.8% to 52.9% and PET from 12.3% to 19.6%, while use of TAB decreased from 50.3% to 33.3%.ConclusionsBiopsy was the most widely used diagnostic test for confirming GCA, but use of imaging as a diagnostic tool has grown in recent years. Following publication of the 2018 EULAR recommendations, ultrasound has displaced biopsy as the first-line diagnostic test; TAB was performed in a third and PET in a fifth of cases.

Performance of the 2022 ACR/EULAR giant cell arteritis classification criteria for diagnosis in patients with suspected giant cell arteritis in routine clinical care

“…7 Newer randomised controlled trials have applied additional inclusion criteria for patients with GCA such as polymyalgia rheumatica, C reactive protein (CRP) or imaging (US, fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT, MRI or CT) [8][9][10][11] and TAB has been replaced by imaging as the first-line diagnostic test in patients with suspected GCA in clinical practice. 12 Therefore, new classification criteria were needed to better reflect current practice. The 2022 ACR/EULAR GCA classification criteria have been recently published using a very consistent methodology, including both a developmental cohort and a validation cohort, yielding a Sens of 87.0% and a specificity (Spec) of 94.8%.…”

“… 7 Newer randomised controlled trials have applied additional inclusion criteria for patients with GCA such as polymyalgia rheumatica, C reactive protein (CRP) or imaging (US, fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT, MRI or CT) 8–11 and TAB has been replaced by imaging as the first-line diagnostic test in patients with suspected GCA in clinical practice. 12 Therefore, new classification criteria were needed to better reflect current practice.…”

Incidence and clinical manifestations of giant cell arteritis in Spain: results of the ARTESER register

“…Furthermore, ultrasound and 18 F-fluorodeoxyglucose positron emission tomography/CT ( 18 F-FDG PET/CT) scan or, alternatively, MRI or CT, have led to an improvement in the detection of extracranial vascular abnormalities in GCA. [5][6][7][8] Some of these aspects have been incorporated into the new GCA classification criteria published in 2022 by the American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology, which could improve the diagnostic accuracy applied in clinical practice compared with those of 1990. [9][10][11][12] Most of the previous epidemiological studies do not include these new imaging diagnostic techniques, therefore, GCA may have been underdiagnosed in the past.…”

Systemic vasculitis: one year in review 2023

“…In the last decades algorithms and procedures used to make the diagnosis of LVV have considerably changed. As shown by a Spanish study (17) examining their nationwide register, temporal artery biopsy (TAB) underwent a slow decline of its application going from being the leading test in 2013 to being used in only a third of cases in 2019. On the other hand, in 2019 more than half diagnoses were established by ultrasound (US) and another 20% by FDG-PET.…”