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0:00
Hello and welcome to Update
on Giant Cell Arteritis.
My name is Alison Clifford,
and I'm a rheumatologist
and associate professor at
the University of Alberta
in Edmonton, Canada.
In 2018, we produced a talk on
giant cell arteritis or GCA,
including an overview
of the epidemiology,
proposed pathogenesis,
clinical features,
and an approach to
diagnosis and treatment.
There've been a
number of exciting
advances in this disease.
Today, we will review some of
the major updates that
have taken place.
0:29
First, with respect
to disclosures,
I've participated as
a site investigator
in clinical trials with
Abbvie, and I've received
honorarium in the past from
UCB to my institution.
0:40
The objectives for today's
talk are as follows.
First, we will review the
new classification criteria
for GCA and discuss the
implications of this work.
Next, we'll discuss updates
in advances in imaging for GCA.
Then lastly, we'll consider
new information
available regarding
the natural history
and prognosis of GCA,
and advances in
treatment options.
1:03
In 2022, new
classification criteria
for identifying giant cell
arteritis patients for research,
were published and endorsed by
the American College of
Rheumatology and EULAR, together.
This represents an important
advance in GCA research
to the previously available
1990 classification criteria,
which frequently
excluded GCA patients
with predominantly
large vessel disease.
The 2022 criteria stipulate
that for inclusion,
patients must be 50 years
or older at diagnosis,
and a weighted score is provided
to assess the presence
of a variety of
clinical, laboratory,
imaging, or biopsy markers
of disease, such
as outlined here.
As compared to the 1990 version,
the 2022 version includes
points for symptoms of
polymyalgia rheumatica,
assesses for the presence
of elevated CRP,
which is more commonly clinically
available than ESR now,
and importantly, emphasizes
the role of imaging
in addition to a biopsy
for disease confirmation,
including temporal
artery ultrasound,
imaging evidence of bilateral
axillary artery involvement,
or PET uptake consistent
with aortitis.
These updated criteria
were validated in
an independent dataset
of over 400 patients,
roughly half of whom had GCA
and half of whom had other
vasculitides or mimics.
The new criteria
were found to have
an improved sensitivity of
87% over the 1990 criteria,
with a similarly high
specificity of 94.8%.
