Diagnosis of Giant Cell Arteritis in Spain: Data from the ARTESER Registry

Eugenio De Miguel¹, Jesús T. Sánchez-Costa², Javier Narvaez³, Miguel Ángel gonzalez-Gay⁴, Noemí Garrido-Puñal⁵, Paula V. Estrada-Alarcon⁶, Iñigo Hernández-Rodríguez⁷, Elisa Fernández-Fernández⁸, María T. Silva-Diaz⁹, Jesús A. Valero-Jaimes¹⁰, Ismael González-Fernández¹¹, Julio Sánchez¹², Judit Lluch¹³, Eva Galindez-Agirregoikoa¹⁴, Javier Mendizábal-Mateos¹⁵, Luis Rodriguez Rodriguez¹⁶, Javier Loricera García¹⁷, Alejandro Muñoz¹⁸, Santos Castañeda¹⁹, Patricia Moya²⁰, Patricia Morán-Álvarez²¹, Vanessa A. Navarro-Angeles⁶, Joan Calvet-Fontova²², Ivette Casafont²³, Francisco Ortiz-Sanjuán²⁴, Selene Labrada-Arrabal²⁵, Cristina Campos-Fernández²⁶, María Alcalde-Villar²⁷, Antonio Juan-Mas²⁸ and Ricardo Blanco²⁹, ¹Hospital Universitario La Paz, Madrid, Spain, ²Spanish Society of Rheumatology, Madrid, Spain, ³Division of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain, ⁴Research group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla; School of Medicine, Universidad de Cantabria, Santander, Spain. Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, ⁵Hospital Universitario Virgen del Rocío, Sevilla, Spain, ⁶Hospital de Sant Joan Despí Moisès Broggi. Sant Joan Despí, Barcelona, Spain, ⁷Complejo Hospitalario Universitario de Vigo, Vigo, Spain, ⁸Rheumatology department, La Paz University Hospital, Madrid, Spain, ⁹Complejo Hospitalario Universitario de La Coruña, Coruña, Spain, ¹⁰Hospital Universitario Donostia, Donostia-San Sebasti, Spain, ¹¹Hospital Universitario de León, León, Spain, ¹²Hospital Universitario 12 de Octubre, Madrid, Spain, ¹³Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain, ¹⁴Hospital Universitario de Basurto, Bilbao, Spain, ¹⁵H. Navarra, Navarra, Spain, ¹⁶Hospital Clinico San Carlos, Madrid, Spain, ¹⁷Hospital Universitario Marqués de Valdecilla, Santander, Spain, ¹⁸Hospital Universitario Virgen del Rocío, Sevial, Spain, ¹⁹Hospital Universitario de la Princesa, Madrid, Spain, ²⁰Hospital Sant Pau, Barcelona, Spain, ²¹Hospital Universitario Ramón y Cajal, Madrid, Spain, ²²Hospital Universitari Parc Tauli, Sabadell, Spain, ²³Hospital Universitari Germans Trias i Pujol, Barcelona, Badalona, Spain, ²⁴H. La Fe, Valencia, Spain, ²⁵Hospital del Mar, Barcelona, Spain, ²⁶Consorci Hospital General Universitari de Valencia, Valencia, Spain, ²⁷Hospital Universitario Severo Ochoa, Leganés, Spain, ²⁸Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain, ²⁹Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

Meeting: ACR Convergence 2021

Keywords: Diagnostic criteria, giant cell arteritis, Imaging, Ultrasound, Vasculitis

Session Information

Date: Saturday, November 6, 2021

Title: Imaging of Rheumatic Diseases Poster (0149–0182)

Session Type: Poster Session A

Session Time: 8:30AM-10:30AM

Background/Purpose: To standardize research studies different classification systems are used. Currently, the ACR Giant Cell Arteritis (GCA) 1990¹classification criteria is probably the most widely used, but the positive predictive value of these criteria is based on the high specificity of temporal artery biopsy (TAB), but a low sensitivity of TAB has been reported. Therefore, in the last EULAR recommendations for the use of imaging in GCA², imaging techniques were accepted as useful in the diagnosis of GCA. This means that the GCA classification criteria are currently under discussion and evolution. Meanwhile, the diagnosis is based on the experience and judgment of the clinician. Our main objective was to know, how the diagnosis of GCA was made in our country and if the publication of the EULAR recommendations has influenced in the diagnosis of GCA in our clinical practice.

Methods: ARTESER is a multicenter observational retrospective study promoted by the Spanish Society of Rheumatology with 26 participating centers and in which all patients diagnosed with GCA between June 1 2013 and March 29 2019 were included. The gold standard for the diagnosis of the disease was the opinion of the responsible physician according to the clinical, analytical, imaging and TAB data available. This analysis includes the data collected from TAB and imaging (ultrasound, PET, and MRI/CT-angiography).

Results: 1675 patients with GCA were included, mean age ± SD (76.9 ± 8.1) years, 1178 women (70.3%). 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%). Figure 1 shows the temporal evolution of TAB and imaging techniques in the diagnosis of GCA throught the study time.

When the patients who had several of these positive tests were analyzed as support of clinical diagnosis, it was found that TAB was the only specific test performed in 531 patients (31.7%), ultrasound in 257 (15.3%), PET in 135 patients (8.1%) and MRI/CT-angiography in 14 patients (0.8%). Likewise, the data collected showed that the diagnosis based on clinical criteria or physician’s opinion without TAB or imaging tests had been made in 417 patients (24.9%).

Conclusion: TAB is the most widely used diagnostic test to confirm GCA. Following the publication of the 2018 EULAR recommendations, ultrasound has displaced TAB as the first diagnostic test. PET is performed in 20% of patients in recent years. There is a wide margin of improvement in the diagnosis of GCA since the clinical diagnosis, without TAB or additional imaging tests, still supports 25% of the diagnoses.

Disclosures: E. De Miguel, Roche, 6, 12, Paid instructor, Abbvie, 2, 5, 6, Novartis, 2, 5, 6, 12, Paid instructor, Pfizer, 2, 5, 6, MSD, 6, BMS, 6, UCB, 6, Grunental, 6, Janssen, 6, 12, Paid instructor, Sanofi, 6, Galapagos, 2; J. Sánchez-Costa, None; J. Narvaez, None; M. gonzalez-Gay, None; N. Garrido-Puñal, None; P. Estrada-Alarcon, None; I. Hernández-Rodríguez, None; E. Fernández-Fernández, None; M. Silva-Diaz, None; J. Valero-Jaimes, None; I. González-Fernández, None; J. Sánchez, None; J. Lluch, None; E. Galindez-Agirregoikoa, None; J. Mendizábal-Mateos, None; L. Rodriguez Rodriguez, None; J. Loricera García, None; A. Muñoz, None; S. Castañeda, None; P. Moya, None; P. Morán-Álvarez, None; V. Navarro-Angeles, None; J. Calvet-Fontova, None; I. Casafont, None; F. Ortiz-Sanjuán, None; S. Labrada-Arrabal, None; C. Campos-Fernández, None; M. Alcalde-Villar, Nordic, 12, Tutor of rheumatology trainee at regional congress; A. Juan-Mas, None; R. Blanco, Brystol Myers Squibb, 6.

To cite this abstract in AMA style:

De Miguel E, Sánchez-Costa J, Narvaez J, gonzalez-Gay M, Garrido-Puñal N, Estrada-Alarcon P, Hernández-Rodríguez I, Fernández-Fernández E, Silva-Diaz M, Valero-Jaimes J, González-Fernández I, Sánchez J, Lluch J, Galindez-Agirregoikoa E, Mendizábal-Mateos J, Rodriguez Rodriguez L, Loricera García J, Muñoz A, Castañeda S, Moya P, Morán-Álvarez P, Navarro-Angeles V, Calvet-Fontova J, Casafont I, Ortiz-Sanjuán F, Labrada-Arrabal S, Campos-Fernández C, Alcalde-Villar M, Juan-Mas A, Blanco R. Diagnosis of Giant Cell Arteritis in Spain: Data from the ARTESER Registry [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/diagnosis-of-giant-cell-arteritis-in-spain-data-from-the-arteser-registry/. Accessed .

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