Performance of the modified 2022 ACR/EULAR giant cell arteritis classification criteria without age restriction for discriminating from Takayasu arteritis

Takahiko Sugihara ^1,2, Masayoshi Harigai ³, Haruhito A Uchida ⁴

¹Department of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan. takahiko.sugihara@med.toho-u.ac.jp.
²Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan. takahiko.sugihara@med.toho-u.ac.jp.
³Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
⁴Department of Chronic Kidney Disease and Cardiovascular Disease, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan.
⁵Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁶Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan.
⁷Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Ehime, Japan.
⁸Department of General Medicine, Kawasaki Medical School, Kurashiki, Japan.
⁹Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
¹⁰Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan.
¹¹Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan.
¹²Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.
¹³Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan.
¹⁴Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

⁰Department of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan. takahiko.sugihara@med.toho-u.ac.jp.

Arthritis Research & Therapy +

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January 31, 2025

View abstract on PubMed

Summary

The modified 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) criteria effectively differentiate giant cell arteritis (GCA) from Takayasu arteritis (TAK) in clinical practice. These criteria show good discriminative ability, even without positron emission tomography-CT, aiding in accurate diagnosis.

Area Of Science

Rheumatology
Vascular Inflammation
Diagnostic Criteria

Background

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are large vessel vasculitides that can present with overlapping symptoms.
Accurate differentiation is crucial for appropriate treatment and management.
The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) classification criteria for GCA were developed to improve diagnostic accuracy.

Purpose Of The Study

To evaluate the diagnostic performance of the modified 2022 ACR/EULAR GCA classification criteria in distinguishing GCA from TAK.
To assess the discriminative ability of the criteria using imaging modalities commonly available in routine practice.

Main Methods

A retrospective analysis of patients diagnosed with GCA (n=139) and TAK (n=129) from a Japanese nationwide registry.
Modified 2022 ACR/EULAR GCA classification criteria were applied, with contrast-enhanced CT or MRI used for aortic wall thickening assessment instead of PET-CT.
Discriminative ability was assessed using the C-statistic, with values > 0.7 indicating good ability.

Main Results

The modified criteria demonstrated good discriminative ability for GCA versus TAK (C-statistic: 0.986).
Sensitivity for GCA was 82.0%, and specificity for distinguishing from TAK was 96.1%.
Discriminative ability remained good even when age was excluded (C-statistic: 0.927), but distinguishing GCA without cranial lesions from TAK required age or polymyalgia rheumatica (PMR) information.

Conclusions

The modified 2022 ACR/EULAR GCA classification criteria are effective for differentiating GCA from TAK in routine clinical settings without the need for PET-CT.
The criteria possess strong discriminative power for GCA and TAK, largely independent of patient age.
Specific clinical features like age or PMR are important for differentiating GCA cases lacking cranial involvement from TAK.

Keywords:

Bilateral axillary artery Bilateral subclavian artery Classification criteria Descending thoracic-abdominal aorta GCA TAK