Journal Article

POS0732 PERFORMANCE OF THE 2022 ACR/EULAR CLASSIFICATION CRITERIA FOR GIANT CELL ARTERITIS IN ROUTINE CLINICAL CARE

Molina Collada, J., Alvaro-Gracia, J.M., De Miguel, E., Fernández-Fernández, E., Torres Ortiz, G., Monjo, I., Castrejon, I.

2023

Overview

The 2022 ACR/EULAR giant cell arteritis (GCA) classification criteria have been designed to improve diagnostic accuracy incorporating vascular imaging modalities and potential large vessel (LV) involvement. These new criteria have been validated in an independent set of patients and controls, with a sensitivity of 87.0% and a specificity of 94.8%, but not tested in routine care. Our objective is to examine the performance of the new 2022 ACR/EULAR GCA classification criteria in this clinical scenario. Multicentric retrospective observational study of patients referred to our ultrasound (US) fast track clinic over a 4-year period. The gold standard for GCA diagnosis was clinical confirmation after 6 months of follow-up. Patients with GCA were compared with unselected controls referred to our clinic with suspected GCA. All patients underwent US exam of temporal and extracranial arteries (carotid, subclavian and axillary) within 24-48 hours at baseline. FDG-PET/CT was performed according to standard clinician criteria. Following the new 2022 GCA ACR/EULAR classification criteria, the total score for the 10 items included in the criteria was calculated, with a total cut-off ≥ 6 for the classification of GCA. The performance of these criteria was evaluated in all GCA patients across different subsets of the disease. A total of 319 patients (188 cases and 131 controls) were included for analysis (mean age 76 years, 58.9% females). Patients with GCA and controls differed in age (78.2 vs 72.9, p<0.001) and sex (females 53.2% vs 67.2%, p=0.013). The diagnostic accuracy of the 2022 ACR/EULAR GCA classification criteria and the previous 1990 ACR GCA classification criteria in different subsets of patients is shown in Table 1. Overall, the new criteria had a sensitivity of 92.6% and a specificity of 74%, using GCA clinical diagnosis as an external criterion and the area under the curve (AUC) was 0.932 (95% CI 0.903 to 0.960). Isolated LV-GCA showed a sensitivity of 62.2% and a specificity of 74% (AUC 0.696 [0.596 – 0.796]) and biopsy-proven GCA showed a sensitivity of 100% and a specificity of 74% (AUC 0.992 [0.981 – 1]). The new 2022 ACR/EULAR GCA classification criteria showed good diagnostic accuracy of patients with suspected GCA under routine care, and a substantial improvement upon the sensitivity and specificity of the 1990 ACR GCA classification criteria in all patients subsets. NIL. NIL. None Declared. Table 1Diagnostic accuracy of the new 2022 ACR/EULAR GCA and the 1990 ACR/EULAR classification criteria, with clinical diagnosis serving as the external criteria in all GCA, patients with isolated cranial GCA, isolated LV-GCA, all LV-GCA and biopsy proven GCA. GCA, giant cell arteritis; LV, large vessel; Sens, sensitivity; Spec, specificity; LR+, positive likelihood ratio; LR−, negative likelihood ratio; AUC: area under the ROC curve analysisSensSpecLR+LR-AUC (95% CI)All GCA (n = 188) vs controls (n = 131)2022 ACR/EULAR criteria92.6%74%3.560.10.932 (0.903 – 0.960)1990 ACR criteria53.2%80.2%2.680.580.719 (0.663 – 0.775)Isolated cranial GCA (n = 83) vs controls (n = 131)2022 ACR/EULAR criteria96.4%74%3.710.050.965 (0.933 – 0.996)1990 ACR criteria61.4%80.2%3.10.480.764 (0.699 – 0.829)Isolated LV-GCA (n = 37) vs controls (n = 131)2022 ACR/EULAR criteria62.2%74%2.390.510.696 (0.596 – 0.796)1990 ACR criteria18.9%80.2%0.951.010.554 (0.455 – 0.653)Biopsy proven GCA (n = 21) vs controls (n = 131)2022 ACR/EULAR criteria100%74%3.8500.992 (0.981 – 1)1990 ACR criteria95.2%80.2%4.810.060.931 (0.877 – 0.985)LV-GCA (with or without cranial GCA) (n = 105) vs control (n=131)2022 ACR/EULAR criteria89.5%74%3.440.140.905 (0.865 – 0.946)1990 ACR criteria46.7%80.2%2.360.660.683 (0.616 – 0.751)

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Accuracy / Arteries / Arteritis / Biopsy / Classification / Decades / Diagnosis / Imaging / Skull / Ultrasound / Vasculitis / Vein & artery diseases