Klinik uygulamada dev hücreli arterit için 2022 ACR/EULAR sınıflandırma kriterlerinin tanısal doğruluğunun değerlendirilmesi

Year 2025, Volume: 6 Issue: 3, 194 - 198, 18.06.2025

Mehmet Nur Kaya , Duygu Tecer , Özlem Kılıç , Sedat Yılmaz

https://doi.org/10.47582/jompac.1625308

Abstract

Amaç: Dev hücreli arterit (DHA) için 2022 Amerikan Romatoloji Koleji (ACR)/Avrupa Romatoloji Birliği (EULAR) sınıflandırma kriterleri, gelişmiş görüntüleme yöntemlerini dahil ederek ve büyük damar tutulumunu ele alarak tanı doğruluğunu artırmak için geliştirilmiştir. Bu çalışma, bu kriterlerin rutin kullanımda performansını değerlendirmektedir.
Yöntemler: Bu çalışma retrospektif ve tek merkezliydi. Mart 2017'den Ocak 2024'e kadar üçüncü basamak bir romatoloji merkezinde rutin olarak takip edilen 25 DHA hastasını içeriyordu. Sınıflandırma kriterlerinin doğruluğu, duyarlılığı, özgüllüğü, pozitif ve negatif prediktif değerleri ve ROC analizi ile eğri altı alan (EAA) karşılaştırıldı.
Bulgular: DHA için 2022 ACR/EULAR sınıflandırma kriterlerinin duyarlılığı (%92,0), özgüllüğü (%92,9), pozitif prediktif değeri (%92,0), negatif prediktif değeri (%92,9), doğruluğu (%92,4) ve EAA'sı (0,979 (0,925-0,998)) DHA için 1990 ACR sınıflandırma kriterlerinden daha yüksekti (%88,0, %85,7, %84,6, %88,9 ve %86,8 sırasıyla) ve EAA'daki fark istatistiksel olarak anlamlıydı (0,871 (0,770-0,973), p < 0,001)
Sonuç: Bu bulgular, 2022 ACR/EULAR kriterlerinin duyarlılığı önemli ölçüde iyileştirdiğini ve 1990 kriterlerine kıyasla yeterli özgüllüğü koruduğunu, bu nedenle klinik uygulamada DHA tanısı için daha değerli hale geldiğini göstermektedir.

Keywords

Dev hücreli arterit , vaskülit , sınıflandırma kriterleri

Evaluating the diagnostic accuracy of the 2022 ACR/EULAR classification criteria for giant cell arteritis in routine clinical practice

Abstract

Aims: The 2022 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria for giant cell arteritis (GCA) were developed to enhance diagnostic accuracy by incorporating advanced imaging modalities and addressing large vessel involvement. This study evaluates the performance of these criteria in routine clinical care.
Methods: This study was retrospective and single-center. The results included 25 GCA patients routinely followed at a tertiary rheumatology center from March 2017 to January 2024. The accuracy, sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic (ROC) curve (AUC) of the classification criteria were compared.
Results: The sensitivity (92.0%), specificity (92.9%), positive predictive value (92.0%), negative predictive value (92.9%), accuracy (92.4%) and AUC (0.979 (0.925-0.998)) of the 2022 ACR/EULAR classification criteria for GCA were higher than those of the 1990 ACR classification criteria for GCA (88.0%, 85.7%, 84.6%, 88.9% and 86.8%, respectively), and the difference in AUC was statistically significant (0.871 (0.770-0.973), p<0.001).
Conclusion: These findings indicate that the 2022 ACR/EULAR criteria significantly improve the sensitivity and maintain adequate specificity compared to the 1990 criteria, making them a valuable tool for diagnosing GCA in clinical practice. The new classification criteria will help to select the right patients and will reduce clinical errors.

Keywords

Giant cell arteritis , vasculitis , classification criteria

References

• Dejaco C, Brouwer E, Mason JC, et al. Giant cell arteritis and polymyalgia rheumatica: current challenges and opportunities. Nat Rev Rheumatol. 2017;13(10):578-592. doi:10.1038/nrrheum.2017.142
• Kermani TA, Schäfer VS, Crowson CS, et al. Increase in age at onset of giant cell arteritis: a population-based study. Ann Rheum Dis. 2010; 69(4):780-781. doi:10.1136/ard.2009.111005
• Bull Haaversen AC, Brekke LK, Kermani TA, et al. Extended ultrasound examination identifies more large vessel involvement in patients with giant cell arteritis. Rheumatology. 2023;62(5):1887-1894. doi:10.1093/rheumatology/keac478
• Hunder GG, Bloch DA, Michel BA, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990;33(8):1122-1128. doi:10.1002/art.1780330810
• Seeliger B, Sznajd J, Robson JC, et al. Are the 1990 American College of Rheumatology vasculitis classification criteria still valid? Rheumatology. 2017;56(7):1154-1161. doi:10.1093/rheumatology/kex075
• Schmidt WA, Dasgupta B, Luqmani R, et al. A Multicentre, randomised, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of sirukumab in the treatment of giant cell arteritis. Rheumatol Ther. 2020;7(4):793-810. doi:10.1007/s40744-020-00227-2
• Venhoff N, Schmidt WA, Lamprecht P, et al. Efficacy and safety of secukinumab in patients with giant cell arteritis: study protocol for a randomized, parallel group, double-blind, placebo-controlled phase II trial. Trials. 2021;22(1):543. doi:10.1186/s13063-021-05520-1
• Ponte C, Grayson PC, Robson JC, et al. 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Arthritis Rheumatol. 2022;74(12):1881-1889. doi:10.1002/art.42325
• Opriș-Belinski D, Cobilinschi CO, Săulescu I. Current perspectives in giant cell arteritis: can we better connect pathogenesis and treatment? Medicina (B Aires). 2024;60(3):400. doi:10.3390/medicina60030400
• Molina-Collada J, Castrejón I, Monjo I, et al. Performance of the 2022 ACR/EULAR giant cell arteritis classification criteria for diagnosis in patients with suspected giant cell arteritis in routine clinical care. RMD Open. 2023;9(2):e002970. doi:10.1136/rmdopen-2022-002970
• Hemmig AK, Aschwanden M, Imfeld S, Berger CT, Daikeler T. A diagnostic performance study of the 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis in a cohort of patients presenting with suspected giant cell arteritis. Arthritis Rheumatol. 2023;75(6):1075-1077. doi:10.1002/art.42440
• Narváez J, Estrada P, Vidal-Montal P, Nolla JM. Performance of the new 2022 ACR/EULAR classification criteria for giant cell arteritis in clinical practice in relation to its clinical phenotypes. Autoimmun Rev. 2023;22(10):103413. doi:10.1016/j.autrev.2023.103413
• Sanchez-Martin J, Medina-Del Valle J, Loricera J, et al. AB0733 concordance between the 1990 ACR classification criteria and the new 2022 ACR/EULAR 2022 criteria in giant cell arteritis. Annals Rheumatic Dis. 2023;82:p.1572.2-1573. doi:10.1136/annrheumdis-2023-eular.6144
• Bergner R, Schulz P, Friedrich J. AB0704 evaluation of the of the 2022 ACR/EULAR classification criteria for GCA in a German patient cohort. Scientific abstracts. Annals Rheumatic Dis. 2023;82:1555-1556. doi:10.1136/annrheumdis-2023-eular.2102
• Andel P, Diamantopoulos A, Myklebust G, Haugeberg G. Vasculitis distribution and clinical characteristics in giant cell arteritis: a retrospective study using the new 2022 ACR/EULAR classification criteria. Front Med (Lausanne). 2023;10:1286601. doi:10.3389/fmed. 2023.1286601
• Nieuwland M van, Bon L van, Vermeer M, et al. External validation of the 2022 ACR/EULAR classification criteria in patients with suspected giant cell arteritis in a Dutch fast-track clinic. RMD Open. 2023;9(3): e003080. doi:10.1136/rmdopen-2023-003080
• Sandal Uzun G, Gokoz O, Heper A, et al. AB0756 identification of histopathologic findings of patients with giant cell arteritis: a multicentre study in the era of 2022 ACR/EULAR classifıcation criteria for GCA. Annals Rheumatic Dis. 2023;2(Suppl 1):p.1584.1-1585. doi:10.1136/annrheumdis-2023-eular.1935