Rheumatology, Department of Clinical Sciences, Lund University, Malmö, UK.
Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden, UK.
Rheumatology (Oxford). 2021 Dec 24;61(1):383-387. doi: 10.1093/rheumatology/keab353.
GCA is a systemic vasculitis of the elderly, viewed by many as a disease with multiple and overlapping clinical phenotypes. Retrospective studies have shown differences in clinical presentation between these phenotypes. To reflect the heterogeneity of GCA and novel diagnostic methods, new classification criteria have been proposed.
This is a retrospective study of newly diagnosed patients with GCA at the outpatient rheumatology clinics at Skåne University Hospital (Malmö and Lund) between 2012 and 2018. All patients were evaluated using two sets of classification criteria, the ACR classification criteria from 1990 and a proposed revision of these criteria requiring objective findings (positive biopsy or imaging) for classification. Patients were further classified as one of four widely used clinical phenotypes.
A total of 183 patients with a new diagnosis of GCA were identified. The diagnosis was confirmed by one or two experienced rheumatologists in 116 of these patients during a review of medical records. The ACR criteria were more sensitive than the revised criteria (93.1% vs 72.4%), but the revised criteria had higher specificity (94.0% vs 28.4%). The revised criteria tended to have higher sensitivity in the phenotype with constitutional symptoms compared with cranial GCA (P = 0.08).
The specificity of the ACR classification criteria for GCA can be improved by using revised criteria requiring objective findings of vasculitis. In addition, the wider symptoms covered by the revised criteria may improve classification of patients with a phenotype characterized by constitutional symptoms.
GCA 是一种老年系统性血管炎，许多人认为它是一种具有多种重叠临床表型的疾病。回顾性研究表明，这些表型之间的临床表现存在差异。为了反映 GCA 的异质性和新的诊断方法，已经提出了新的分类标准。
这是一项在 2012 年至 2018 年间在斯科讷大学医院（马尔默和隆德）的门诊风湿病诊所新诊断为 GCA 的患者的回顾性研究。所有患者均使用两套分类标准进行评估，一套是 1990 年的 ACR 分类标准，另一套是需要客观发现（阳性活检或影像学）才能分类的标准修订版。患者进一步分为四种广泛使用的临床表型之一。
共确定了 183 例新诊断为 GCA 的患者。在对这些患者中的 116 名患者的病历进行审查期间，由一到两名经验丰富的风湿病学家确诊。ACR 标准比修订后的标准更敏感（93.1%比 72.4%），但修订后的标准特异性更高（94.0%比 28.4%）。修订后的标准在有全身症状的表型中与颅 GCA 相比，具有更高的敏感性（P=0.08）。
通过使用需要血管炎客观发现的修订标准，可以提高 ACR 分类标准对 GCA 的特异性。此外，修订后的标准涵盖的更广泛的症状可能会改善以全身症状为特征的患者的分类。
