Background/Purpose: Classification criteria for vasculitis, including giant cell arteritis (GCA) are under constant revision. In 2022, the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria were presented, renewing those published by ACR in 1990. They include wider range of clinical criteria and imaging tests, such as ultrasonography (US) and Positron emission tomography (PET), which has contributed to the diagnosis of a higher number of cases.

The objective of this study was to assess the concordance between recent 2022 ACR/EULAR giant cell arteritis classification criteria and the criteria of ACR 1990 (1,2).

Methods: Observational study of patients diagnosed with GCA who underwent temporal artery biopsy (TAB) between 2016 and 2022 in an university hospital. Concordance between both sets of criteria were analyzed with Cohen’s kappa index.

Results: We present 191 patients (120 female/71 male) (mean±SD; 75±10 years). The main characteristics of the patients are shown in Table. The Kappa index between both criteria weighted by prevalence and bias was 0.654 (moderate-high degree of agreement). Global agreement of 83% was observed, with a higher specific agreement for negative results (88%) than for positive results (67%). Disagreement was observed in 16% of patients who were considered negative for ACR 1990 criteria but positive for ACR/EULAR 2022 criteria and in 2% who were considered positive for ACR 1990 criteria but negative for ACR/EULAR 2022. 2022 ACR/EULAR showed a higher sensitivity, and 27 additional patients were classified as GCA with these classification criteria.

Conclusion: Moderate-high concordance was found between 2022 ACR/EULAR and 1990 ACR classification criteria. However, the 2022 ACR/EULAR criteria consider a wider range of factors than the 1990 ACR criteria by introducing US and PET findings, thus increasing sensitivity and allowing a larger number of patients to be diagnosed. Cranial GCA was the most frequent phenotype observed.

References:
Ponte C, et al. Arthritis Rheumatol. 2022. PMID: 36350123
Hunder GG, et al. Arthritis Rheum. 1990. PMID: 2202311

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/concordance-between-the-1990-acr-classification-criteria-and-the-new-2022-acr-eular-2022-criteria-in-giant-cell-arteritis/