The Prognostic Value of the “2022 ACR/EULAR Classification Criteria for Giant Cell Arteritis”: Data from the Italian Society of Rheumatology Vasculitis Study Group

Alessandro Tomelleri¹, Corrado Campochiaro², Francesco Muratore³, Sara Monti⁴, Nicola Farina⁵, Chiara Marvisi⁶, Elena Galli⁷, Alessandra Milanesi⁸, Naomi Viapiana⁵, Alvise Berti⁹, Roberto Bortolotti⁹, Milena Bond¹⁰, Roberto Padoan¹¹, Mara Felicetti⁹, Franco Schiavon¹², Carlotta Nannini¹³, Fabrizio Cantini¹³, Alessandro Giollo¹⁴, Maurizio Rossini¹⁵, Edoardo Conticini¹⁶, Bruno Frediani¹⁷, Fabrizio Conti¹⁸, Roberta Priori¹⁸, Marco Sebastiani¹⁹, Giulia Cassone²⁰, Luca Quartuccio Quartuccio²¹, Elena Treppo²², Silvano Bettio²³, Ariela Hoxha²⁴, Marco Lovisotto²⁴, Giacomo Emmi²⁵, irene mattioli²⁶, Pietro Leccese²⁷, Roberto F. Caporali²⁸, Lorenza Maria Argolini²⁹, Rosario Foti³⁰, Elisa Visalli³⁰, Michele Colaci³¹, Carlomaurizio Montecucco³², Lorenzo Dagna³³ and Carlo Salvarani³⁴, ¹Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milano, Italy, ²IRCCS San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Disease. Vita-Salute San Raffaele University, Milan, Italy, ³IRCCS di Reggio Emilia, Reggio Emilia, Italy, ⁴Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy, ⁵IRCCS San Raffaele Hospital, Milan, Italy, ⁶IRCCS di Reggio Emilia, Reggio Emilia, Italy, Reggio Emilia, Italy, ⁷Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy, ⁸Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, ⁹Santa Chiara Hospital of Trento, Trento, Italy, ¹⁰Azienda sanitaria dell'Alto Adige, Merano, Italy, ¹¹Department of Medicine DIMED, University of Padova, Padova, Italy, ¹²University of Padova, Padova, Italy, ¹³Santo Stefano Hospital Prato, Prato, Italy, ¹⁴Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy, ¹⁵Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy, ¹⁶Tallaght University Hospital, Dublin, Ireland, ¹⁷University of Siena, Siena, Italy, ¹⁸University of Rome La Sapienza, Rome, Italy, ¹⁹Azienda Policlinico di Modena, Modena, Italy, ²⁰University of Modena and Reggio Emilia, Modena, Italy, ²¹Rheumatology Division, Department of Medicine, University of Udine, Udine, Italy, ²²Physician, Moimacco, Italy, ²³University of Padua, Treviso, Italy, ²⁴San Bortolo Hospital of Vicenza, Vicenza, Italy, ²⁵University of Florence, Florence, Italy, ²⁶University of Florence, Firenze, Italy, ²⁷Regional Hospital San Carlo, Potenza, Italy, ²⁸Department of Clinical Sciences and Community Health, University of Milan, and Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO, Milano, Italy, ²⁹ASST Gaetano Pini, Milano, Italy, ³⁰AOU San Marco, Catania, Catania, Italy, Catania, Italy, ³¹University of Catania, Catania, Italy, ³²Unità Operativa e Cattedra di Reumatologia, IRCCS Policlinico S Matteo, Pavia, Italy, ³³Ospedale San Raffaele, Milano, Italy, ³⁴Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy

Meeting: ACR Convergence 2023

Keywords: giant cell arteritis, prognostic factors, Vasculitis

Session Information

Date: Tuesday, November 14, 2023

Title: Abstracts: Vasculitis – Non-ANCA-Associated & Related Disorders II: Clinical

Session Type: Abstract Session

Session Time: 4:00PM-5:30PM

Background/Purpose: The 2022 classification criteria for giant cell arteritis (GCA) have been recently published. The aim of this study is to investigate whether the score obtained by summing clinical and laboratory items and the fulfillment of each item correlate with prognosis.

Methods: Data of GCA patients from centres belonging to the Italian Society of Rheumatology Vasculitis Group were retrospectively reviewed. Baseline clinical/laboratory items included in the 2022 GCA classification criteria were retrieved and summed to obtain a total score (from 0 to 16). Therapy-related complications, disease-related outcomes and need for disease-modifying drug (DMARD) introduction at baseline (only for visual loss [VL]), at 12 months and at 60 months were evaluated. Univariate and multivariate logistic analyses were performed.

Results: 873 patients (mean score, 8.1 ± 3.3; mean items fulfilled per-patient, 4.2 ± 1.6) were included. Follow-up data were available for all patients at 12 months and for 467 (53.4%) patients at 60 months. At GCA onset, 165 (18.9%) patients had VL. At 12 and 60 months, 41 (4.7%) and 28 (6.0%) patients developed ascending aorta aneurysm (AAA), 86 (9.9%) and 45 (9.6%) patients suffered from osteoporotic fractures (OF), 49 (5.6%) and 19 (4.1%) patients developed diabetes, respectively. 331 (38%) and 224 (48.0%) patients were prescribed ≥1 DMARD within 12 and 60 months, respectively.

At univariate analysis, a higher score (excluding ‘VL’) was associated with VL (OR 1.551 [95%CI 1.439-1.672], p< 0.0001). A higher score was associated with AAA (OR 0.769 [0.687-0.860], p=0.0012; 0.814 [0.718-0.923], p=0.0014) at 12 and 60 months, OF (OR 1.102 [1.029-1.180], p=0.0057, 1.171 [1.064-1.290], p=0.0013) at 12 and 60 months, diabetes at 60 months (OR 0.856 [0.740-0.990], p=0.0364), and need for DMARD introduction at 12 (OR 0.948 [0.909-0.989], p=0.0135) and 60 months (OR 0.902 [0.853-0.955], p=0.0003). A score < 7 was associated with DMARD introduction at both timepoints (Figure).

At multivariate analysis, jaw/tongue claudication and temporal artery abnormality were directly associated with whereas polymyalgic symptoms and CRP ≥10 mg/L were inversely associated with VL. Jaw/tongue claudication was associated with a lower risk of AAA and higher risk of OF at 12 months and with a higher risk of OF at 60 months; headache with a lower risk of AAA at 60 months and VL with a higher risk of OF at 12 months (Table).

Conclusion: Considering only clinical and laboratory items, a higher score obtained from the 2022 GCA classification criteria is positively associated with VL and OF, and negatively with AAA and diabetes. A score < 7 is associated with a higher probability of receiving a DMARD. Cranial symptoms increase the risk of VL and OF but reduce the risk of AAA. PMR symptoms and high CRP levels are protective for VL.

Figure legend. Cumulative incidence of DMARD introduction in patients with a score <7 (blue line) and in patients with a score ≥7 (red line) at 12 (A) and 60 months (B).

Table legend. Univariate and multivariate logistic analyses evaluating the association of each item with different outcomes.

Disclosures: A. Tomelleri: Novartis, 1; C. Campochiaro: Boehringer Ingelheim, 1, 6, Janssen, 1, 6, Novartis, 1, 6; F. Muratore: None; S. Monti: CSL Vifor, 6; N. Farina: None; C. Marvisi: None; E. Galli: None; A. Milanesi: None; N. Viapiana: None; A. Berti: None; R. Bortolotti: None; M. Bond: AbbVie/Abbott, 5; R. Padoan: GlaxoSmithKlein(GSK), 6; M. Felicetti: None; F. Schiavon: None; C. Nannini: None; F. Cantini: None; A. Giollo: Eli Lilly, 6, galapagos, 2, 6, Novartis, 2, Sandoz, 2; M. Rossini: None; E. Conticini: None; B. Frediani: None; F. Conti: None; R. Priori: None; M. Sebastiani: None; G. Cassone: None; L. Quartuccio: None; E. Treppo: None; S. Bettio: None; A. Hoxha: None; M. Lovisotto: None; G. Emmi: AstraZeneca, 2, Boehringer-Ingelheim, 2, GlaxoSmithKlein(GSK), 2, Novartis, 2, Sanofi, 2, Sobi, 2; i. mattioli: None; P. Leccese: None; R. Caporali: AbbVie, 2, 6, Amgen, 2, 6, BMS, 2, 6, Celltrion, 2, 6, Fresenius Kabi, 2, Galapagos, 2, 6, Janssen, 2, 6, Lilly, 2, 6, MSD, 2, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 2, Sandoz, 2, 6, UCB, 2, 6; L. Argolini: None; R. Foti: None; E. Visalli: None; M. Colaci: None; C. Montecucco: None; L. Dagna: AbbVie/Abbott, 2, AstraZeneca, 2, biogen, 2, Boehringer-Ingelheim, 2, Bristol-Myers Squibb(BMS), 2, 5, Eli Lilly, 2, galapagos, 2, GlaxoSmithKlein(GSK), 2, Janssen, 2, Kiniksa Pharmaceuticals, 2, Novartis, 2, 6, Pfizer, 2, 5, SOBI, 2, 5, 6; C. Salvarani: CSL Vifor, 1, 2, 6, Eli Lilly, 1, 2, 6.

To cite this abstract in AMA style:

Tomelleri A, Campochiaro C, Muratore F, Monti S, Farina N, Marvisi C, Galli E, Milanesi A, Viapiana N, Berti A, Bortolotti R, Bond M, Padoan R, Felicetti M, Schiavon F, Nannini C, Cantini F, Giollo A, Rossini M, Conticini E, Frediani B, Conti F, Priori R, Sebastiani M, Cassone G, Quartuccio L, Treppo E, Bettio S, Hoxha A, Lovisotto M, Emmi G, mattioli i, Leccese P, Caporali R, Argolini L, Foti R, Visalli E, Colaci M, Montecucco C, Dagna L, Salvarani C. The Prognostic Value of the “2022 ACR/EULAR Classification Criteria for Giant Cell Arteritis”: Data from the Italian Society of Rheumatology Vasculitis Study Group [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/the-prognostic-value-of-the-2022-acr-eular-classification-criteria-for-giant-cell-arteritis-data-from-the-italian-society-of-rheumatology-vasculitis-study-group/. Accessed .

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