Sugihara Takahiko, Harigai Masayoshi, Uchida Haruhito A, Yoshifuji Hajime, Maejima Yasuhiro, Ishizaki Jun, Watanabe Yoshiko, Dobashi Hiroaki, Komagata Yoshinori, Tamura Naoto, Nakaoka Yoshikazu
Department of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan.
Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan.
Arthritis Res Ther. 2025 Jan 31;27(1):19. doi: 10.1186/s13075-025-03486-y.
To evaluate the ability to discriminate giant cell arteritis (GCA) from Takayasu arteritis (TAK) according to the modified 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) GCA classification criteria.
Patients enrolled in the Japanese nationwide retrospective registry were evaluated using the criteria with partial modification; wall thickening of descending thoracic-abdominal aorta were mainly diagnosed by contrast-enhanced computed tomography (CT) or magnetic resonance imaging instead of evaluating with positron emission tomography (PET)-CT. The discriminability of the criteria was evaluated using C-statistic (> 0.7: good ability).
Newly diagnosed patients with GCA (n = 139) and TAK (n = 129) were assessed, and 23.3% of TAK were aged 50 years or older at onset. The sensitivity of the modified 2022 ACR/EULAR GCA classification criteria with a score ≥ 6 was 82.0%, 68.5%, and 32.1% in all GCA, GCA with large-vessel involvement, and GCA without cranial arteritis, respectively. The specificity of the modified criteria was 96.1% for the 129 TAK as controls. Five patients with late-onset TAK met the modified criteria, and four had cranial signs and symptoms, two had bilateral axillary artery involvement, and four had descending thoracic-abdominal aorta involvement. The discriminability of the criteria was good (C-statistic: 0.986, 95% confidence interval [CI]: 0.976-0.996) and remained good after excluding age (C-statistic: 0.927, 95% CI: 0.894-0.961). The discriminability of a set of large-vessel lesions (bilateral axillary artery and descending thoracic-abdominal aorta) and inflammatory markers was markedly decreased with poor C-statistic value (C-statistic: 0.598, 95% CI: 0.530-0.667). Discriminability was improved after adding polymyalgia rheumatica (PMR) (C-statistic: 0.757, 95% CI: 0.700-0.813) or age (C-statistic: 0.913, 95%CI: 0.874-0.951) to the set of large-vessel lesions. In GCA patients with a score ≤ 5, 52% had bilateral subclavian and/or axillary artery involvement.
The modified 2022 ACR/EULAR GCA classification criteria well performed in classifying GCA and TAK without PET-CT in routine clinical practice. A set of items included in the modified GCA classification criteria had good discriminative ability for GCA and TAK, even when age was excluded. However, age restriction or PMR was required to distinguish GCA without cranial lesions from TAK.
根据2022年修订的美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）巨细胞动脉炎（GCA）分类标准，评估鉴别GCA与大动脉炎（TAK）的能力。
对纳入日本全国性回顾性登记处的患者使用经部分修改的标准进行评估；降主动脉-腹主动脉壁增厚主要通过增强计算机断层扫描（CT）或磁共振成像诊断，而非使用正电子发射断层扫描（PET）-CT进行评估。使用C统计量（>0.7：鉴别能力良好）评估标准的鉴别能力。
对新诊断的GCA患者（n = 139）和TAK患者（n = 129）进行了评估，23.3%的TAK患者发病时年龄在50岁及以上。在所有GCA、有大血管受累的GCA和无颅动脉炎的GCA中，评分≥6的2022年修订ACR/EULAR GCA分类标准的敏感性分别为82.0%、68.5%和32.1%。以129例TAK患者作为对照，修订标准的特异性为96.1%。5例迟发性TAK患者符合修订标准，4例有颅部体征和症状，2例双侧腋动脉受累，4例降主动脉-腹主动脉受累。该标准的鉴别能力良好（C统计量：0.986，95%置信区间[CI]：0.976 - 0.996），排除年龄因素后仍保持良好（C统计量：0.927，95%CI：0.894 - 0.961）。一组大血管病变（双侧腋动脉和降主动脉-腹主动脉）及炎症标志物的鉴别能力明显下降，C统计量值较差（C统计量：0.598，95%CI：0.530 - 0.667）。在大血管病变组中加入风湿性多肌痛（PMR）（C统计量：0.757，95%CI：0.700 - 0.813）或年龄（C统计量：0.913，95%CI：0.874 - 0.951）后，鉴别能力得到改善。在评分≤5的GCA患者中，52%有双侧锁骨下和/或腋动脉受累。
2022年修订的ACR/EULAR GCA分类标准在常规临床实践中不使用PET-CT对GCA和TAK进行分类时表现良好。修订的GCA分类标准中的一组项目对GCA和TAK具有良好的鉴别能力，即使排除年龄因素也是如此。然而，需要年龄限制或PMR来区分无颅部病变的GCA与TAK。
