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

Collada, J. Molina; Castrejón, Isabel; Monjo, I.; Fernández-Fernández, E.; Ortiz, Gabriela Torres; Álvaro‐Gracia, José María; Miguel, Eugenio de

doi:10.1136/rmdopen-2022-002970

Cited by 18 publications

(9 citation statements)

References 25 publications

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“…This has been noted on a separate retrospective review of several CDUS scans used in the data collection; however, the significance remains unclear as static ultrasound appears inferior to real-time ultrasound, though not formally evaluated in GCA. 24 The ACR/EULAR 2022 classification criteria also performed at lower sensitivity and specificity in our study compared to a recent review of their performance in the United States, 22 which noted a sensitivity of 92.6% and specificity of 71.8%.…”

Section: Discussioncontrasting

confidence: 53%

“…4 Our study documented lower sensitivities of TAB and CDUS compared to those in Counties Manukau 16 and other world-wide studies. [18][19][20][21][22] TAB is a difficult investigation to acquire in Waikato Hospital due to local referral issues and an under-resourced vascular department, where biopsies commonly occur outside of the optimal window. This may account for the lower positive biopsy rates.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology of giant cell arteritis in Waikato, Aotearoa New Zealand

van Dantzig,

Quincey,

Kurz

et al. 2024

NZMJ

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aim: Giant cell arteritis (GCA) is the most common primary vasculitis in adults over 50 years of age. Our primary objective was to assess the incidence and prevalence of GCA in Waikato in a bid to deepen our understanding of the epidemiology of GCA in Aotearoa New Zealand. methods: From January 2014 to December 2022, cases of GCA were identified prospectively and retrospectively through temporal artery ultrasound request lists and temporal artery biopsy histology reports. Using electronic health records, data were collected retrospectively on patient demographics and clinical features. These were used to calculate the incidence, prevalence and standardised mortality ratio (SMR) of GCA in Waikato. results: There were 214 patients diagnosed with GCA over the 9-year period. The majority of patients were European (93.9%, 201/214) with Māori patients being significantly younger than European patients. The mean annual incidence of clinical GCA was 14.7 per 100,000 people over 50 years (95% confidence interval [CI] 12.7–16.6). The SMR was 1.18 (95% CI 0.83–1.52). conclusion: This is the largest study to date on the epidemiology of GCA in Aotearoa New Zealand. The incidence of GCA is comparable to other studies performed in Aotearoa New Zealand and appears to be stable over time. GCA is uncommon in Māori, Pacific Islander and Asian ethnic groups.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Epidemiology of giant cell arteritis in Waikato, Aotearoa New Zealand

van Dantzig,

Quincey,

Kurz

et al. 2024

NZMJ

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“…Our results are in line with the findings of our Spanish colleagues recently published in this journal. 8 The updated classification criteria better reflect the increasing use of imaging modalities for GCA diagnosis, of which the importance is addressed before in EULAR recommendations for GCA in clinical practice. 6 9 Furthermore, extracranial LV-GCA manifestations are incorporated by including imaging modalities visualising LV-GCA.…”

Section: Discussionmentioning

confidence: 99%

“…Our results are in line with the findings of our Spanish colleagues recently published in this journal. 8 …”

Section: Discussionmentioning

confidence: 99%

External validation of the 2022 ACR/EULAR classification criteria in patients with suspected giant cell arteritis in a Dutch fast-track clinic

et al. 2023

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ObjectiveRecently the Diagnostic and Classification Criteria in Vasculitis Study group developed and published new American College of Rheumatology/EULAR classification criteria for giant cell arteritis (GCA). To test robustness in a different clinical setting and inform clinicians on performance in clinical practice, we aim to externally validate them in patients with a suspicion of GCA referred to our GCA fast-track clinic.MethodsPatients with suspected GCA from the Hospital Group Twente Early GCA in Twente prospective cohort were included. The clinical diagnosis of GCA verified after 6 months of follow-up made by the treating rheumatologist was used as a reference standard. A cut-off score of ≥6 was tested as described in the original article. Area under the receiver operating characteristics curve, sensitivity and specificity were calculated.ResultsIn total, 133 patients with suspected GCA were included, of whom 53 were diagnosed with GCA and 80 patients were not diagnosed with GCA. The area under the curve (AUC) was 0.96 (95% CI 0.92 to 0.98). Using the proposed cut-off score of≥6, we found that sensitivity was 98.0% (95% CI 89.9% to 100%) and specificity was 57.5% (95% CI 45.9% to 68.5%). The majority of misclassified patients without GCA had classification scores of 6 and 7 as clinical and/or laboratory criteria were often present in our non-GCA population.ConclusionOur results showed an excellent AUC and sensitivity with a moderate specificity for classification of GCA patients. Considering our relevant study population, we found that the new classification criteria might also be useful for diagnostic purposes, albeit with careful interpretation.

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“…[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.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

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

Fernández-Lozano,

Hernández-Rodríguez,

Narvaez

et al. 2024

RMD Open

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ObjectiveThis study aimed to estimate the incidence of giant cell arteritis (GCA) in Spain and to analyse its clinical manifestations, and distribution by age group, sex, geographical area and season.MethodsWe included all patients diagnosed with GCA between 1 June 2013 and 29 March 2019 at 26 hospitals of the National Health System. They had to be aged ≥50 years and have at least one positive results in an objective diagnostic test (biopsy or imaging techniques), meet 3/5 of the 1990 American College of Rheumatology classification criteria or have a clinical diagnosis based on the expert opinion of the physician in charge. We calculated incidence rate using Poisson regression and assessed the influence of age, sex, geographical area and season.ResultsWe identified 1675 cases of GCA with a mean age at diagnosis of 76.9±8.3 years. The annual incidence was estimated at 7.42 (95% CI 6.57 to 8.27) cases of GCA per 100 000 people ≥50 years with a peak for patients aged 80–84 years (23.06 (95% CI 20.89 to 25.4)). The incidence was greater in women (10.06 (95% CI 8.7 to 11.5)) than in men (4.83 (95% CI 3.8 to 5.9)). No significant differences were found between geographical distribution and incidence throughout the year (p=0.125). The phenotypes at diagnosis were cranial in 1091 patients, extracranial in 337 patients and mixed in 170 patients.ConclusionsThis is the first study to estimate the incidence of GCA in Spain at a national level. We found a predominance among women and during the ninth decade of life with no clear variability according to geographical area or seasons of the year.

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

Cited by 18 publications

References 25 publications

Epidemiology of giant cell arteritis in Waikato, Aotearoa New Zealand

Epidemiology of giant cell arteritis in Waikato, Aotearoa New Zealand

External validation of the 2022 ACR/EULAR classification criteria in patients with suspected giant cell arteritis in a Dutch fast-track clinic

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

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