The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis

Abstract

Criteria for the classification of giant cell (temporal) arteritis were developed by comparing 214 patients who had this disease with 593 patients with other forms of vasculitis. For the traditional format classification, 5 criteria were selected: age 1 5 0 years at disease onset, new onset of localized headache, temporal artery tenderness or decreased temporal artery pulse, elevated erythrocyte sedimentation rate (Westergren) 2 5 0 mml hour, and biopsy sample including an artery, showing necrotizing arteritis, characterized by a predominance of mononuclear cell infiltrates or a granulomatous process with multinucleated giant cells. The presence of 3 or more of these 5 criteria was associated with a sensitivity of 93.5% and a specificity of 91.2%. A classijication tree was also constructed using 6 criteria. These criteria were the same as for the traditional format, except that elevated erythrocyte sedimentation rate was excluded, and 2 other variables were included: scalp tenderness and claudication of the jaw or tongue or on deglutition. The classification tree was associated with a sensitivity of 95.3% and specificity of 90.7%.

Is 18F‐fluorodeoxyglucose positron emission tomography scanning a reliable way to assess disease activity in takayasu arteritis?

“…The presence of a temporal artery abnormality, new-onset headache, visual loss, jaw claudication, and polymyalgia rheumatica were carefully excluded in patients older than 50 years. These latter patients had negative temporal artery biopsy findings, and none of them fulfilled the ACR criteria for giant cell arteritis (10). A total of 12 followup scans were performed in 8 patients.…”

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

“…High-risk conditions and historical features (see Table 8). 59,[75][76][77] 72 Age >50 y 3 criteria are present (sensitivity >90%; specificity >90%) Recent-onset localized headache Temporary artery tenderness or pulse attenuation Elevated erythrocyte sedimentation >50 mm/h Arterial biopsy shows necrotizing vasculitis Behçet disease 73 Oral ulceration Oral ulceration plus 2 of the other 3 criteria Recurrent genital ulceration Uveitis or retinal vasculits Skin lesions-erythema nodosum, pseudo-folliculitis, or pathergy Ankylosing spondylitis 74 Onset of pain <40 83 …”

An atypical presentation of giant cell arteritis

“…Classic features of giant cell arteritis include headache, claudication of the jaw and tongue, loss of vision in one eye, fever, myalgia, weight loss, anorexia and fatigue (Table 1). [2][3][4] Diagnostic criteria established by the American College of Rheumatology (Box 1) 5 reportedly have a sensitivity of 93.5% and a specificity of 91.2%; however, as many as 40% of presentations may be atypical. 4 Fifteen per cent of patients may present with fever alone.…”