Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.
Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.
Ann Rheum Dis. 2022 Dec;81(12):1647-1653. doi: 10.1136/ard-2022-223480. Epub 2022 Nov 9.
To develop and validate updated classification criteria for giant cell arteritis (GCA).
Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in six phases: (1) identification of candidate items, (2) prospective collection of candidate items present at the time of diagnosis, (3) expert panel review of cases, (4) data-driven reduction of candidate items, (5) derivation of a points-based risk classification score in a development data set and (6) validation in an independent data set.
The development data set consisted of 518 cases of GCA and 536 comparators. The validation data set consisted of 238 cases of GCA and 213 comparators. Age ≥50 years at diagnosis was an absolute requirement for classification. The final criteria items and weights were as follows: positive temporal artery biopsy or temporal artery halo sign on ultrasound (+5); erythrocyte sedimentation rate ≥50 mm/hour or C reactive protein ≥10 mg/L (+3); sudden visual loss (+3); morning stiffness in shoulders or neck, jaw or tongue claudication, new temporal headache, scalp tenderness, temporal artery abnormality on vascular examination, bilateral axillary involvement on imaging and fluorodeoxyglucose-positron emission tomography activity throughout the aorta (+2 each). A patient could be classified as having GCA with a cumulative score of ≥6 points. When these criteria were tested in the validation data set, the model area under the curve was 0.91 (95% CI 0.88 to 0.94) with a sensitivity of 87.0% (95% CI 82.0% to 91.0%) and specificity of 94.8% (95% CI 91.0% to 97.4%).
The 2022 American College of Rheumatology/EULAR GCA classification criteria are now validated for use in clinical research.
制定并验证巨细胞动脉炎（GCA）的更新分类标准。
招募血管炎或对照疾病患者进入国际队列。该研究分六个阶段进行：（1）确定候选项目，（2）前瞻性收集诊断时存在的候选项目，（3）专家小组审查病例，（4）基于数据减少候选项目，（5）在开发数据集内推导基于分数的风险分类评分，（6）在独立数据集内验证。
开发数据集包含 518 例 GCA 和 536 例对照。验证数据集包含 238 例 GCA 和 213 例对照。诊断时年龄≥50 岁是分类的绝对要求。最终的标准项目和权重如下：阳性颞动脉活检或超声颞动脉晕征（+5）；红细胞沉降率≥50mm/h 或 C 反应蛋白≥10mg/L（+3）；突发性视力丧失（+3）；肩部或颈部、下颌或舌跛行、新颞动脉头痛、头皮压痛、血管检查时颞动脉异常、双侧腋窝受累的影像学检查和氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）主动脉全程活性（每项+2）。患者可累积评分≥6 分归类为 GCA。当在验证数据集中测试这些标准时，模型的曲线下面积为 0.91（95%置信区间 0.88 至 0.94），敏感性为 87.0%（95%置信区间 82.0%至 91.0%），特异性为 94.8%（95%置信区间 91.0%至 97.4%）。
2022 年美国风湿病学会/欧洲抗风湿病联盟 GCA 分类标准现已验证可用于临床研究。
