Validation and clinical application of 2022 ACR/EULAR criteria for Takayasu arteritis in a large Chinese cohort.

OBJECTIVE

To validate the performance of the 2022 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for Takayasu arteritis (TAK) in a China cohort and examine its performance in clinical practices.

METHODS

778 patients with TAK and 378 patients with non-TAK were included. The sensitivity, specificity, positive and negative predictive values, accuracy, and AUC of the 2022 ACR/EULAR and 1990 ACR criteria were assessed. Furthermore, the Kaplan-Meier curve was used to analyze the impact of high and low scores on prognosis according to the 2022 ACR/EULAR criteria for TAK.

RESULTS

In this Chinese cohort, the 2022 ACR/EULAR criteria demonstrated superior performance with a sensitivity of 95.2% (95% CI: 93.4%-96.5%), specificity of 95.8% (93.1%-97.5%), and an AUC of 0.955 (0.940-0.970), compared with the 1990 ACR criteria, which had a sensitivity of 93.6% (91.6%-95.1%), specificity of 92.3% (89.0%-94.7%), and an AUC of 0.930 (0.911-0.948). Based on the 2022 ACR/EULAR criteria, false-negative cases had fewer vascular ischaemia symptoms and less affected arterial regions than true positives, while false positives mainly differed in angina and blood pressure. Survival analysis indicated that patients with scores ≥15 had significantly lower overall survival rates than those with scores <15, highlighting the need for increased clinical attention to these patients.

CONCLUSION

Compared with the 1990 ACR criteria, the 2022 ACR/EULAR criteria for TAK demonstrate better specificity and sensitivity in real-world clinical practice. The score derived from the 2022 classification criteria is related to the prognosis.