2561: The Prognostic Value of the “2022 ACR/EULAR Classification Criteria for Giant Cell Arteritis”: Data from the Italian Society of Rheumatology Vasculitis Study Group
IRCCS San Raffaele Hospital, Milan, Italy Milano, Milan, Italy
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Alessandro Tomelleri1, Corrado Campochiaro2, Francesco Muratore3, Sara Monti4, Nicola Farina5, Chiara Marvisi6, Elena Galli7, Alessandra Milanesi8, Naomi Viapiana5, Alvise Berti9, Roberto Bortolotti9, Milena Bond10, Roberto Padoan11, Mara Felicetti9, Franco Schiavon12, Carlotta Nannini13, Fabrizio Cantini13, Alessandro Giollo14, Maurizio Rossini15, Edoardo Conticini16, Bruno Frediani17, Fabrizio Conti18, Roberta Priori18, Marco Sebastiani19, Giulia Cassone20, Luca Quartuccio Quartuccio21, Elena Treppo22, Silvano Bettio23, Ariela Hoxha24, Marco Lovisotto24, Giacomo Emmi25, irene mattioli26, Pietro Leccese27, Roberto F. Caporali28, Lorenza Maria Argolini29, Rosario Foti30, Elisa Visalli30, Michele Colaci31, Carlomaurizio Montecucco32, Lorenzo Dagna33 and Carlo Salvarani34, 1Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milano, Italy, 2IRCCS San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Disease. Vita-Salute San Raffaele University, Milan, Italy, 3IRCCS di Reggio Emilia, Reggio Emilia, Italy, 4Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy, 5IRCCS San Raffaele Hospital, Milan, Italy, 6IRCCS di Reggio Emilia, Reggio Emilia, Italy, Reggio Emilia, Italy, 7Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy, 8Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, 9Santa Chiara Hospital of Trento, Trento, Italy, 10Azienda sanitaria dell'Alto Adige, Merano, Italy, 11Department of Medicine DIMED, University of Padova, Padova, Italy, 12University of Padova, Padova, Italy, 13Santo Stefano Hospital Prato, Prato, Italy, 14Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy, 15Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy, 16Tallaght University Hospital, Dublin, Ireland, 17University of Siena, Siena, Italy, 18University of Rome La Sapienza, Rome, Italy, 19Azienda Policlinico di Modena, Modena, Italy, 20University of Modena and Reggio Emilia, Modena, Italy, 21Rheumatology Division, Department of Medicine, University of Udine, Udine, Italy, 22Physician, Moimacco, Italy, 23University of Padua, Treviso, Italy, 24San Bortolo Hospital of Vicenza, Vicenza, Italy, 25University of Florence, Florence, Italy, 26University of Florence, Firenze, Italy, 27Regional Hospital San Carlo, Potenza, Italy, 28Department of Clinical Sciences and Community Health, University of Milan, and Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO, Milano, Italy, 29ASST Gaetano Pini, Milano, Italy, 30AOU San Marco, Catania, Catania, Italy, Catania, Italy, 31University of Catania, Catania, Italy, 32Unità Operativa e Cattedra di Reumatologia, IRCCS Policlinico S Matteo, Pavia, Italy, 33Ospedale San Raffaele, Milano, Italy, 34Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
Background/Purpose: The 2022 classification criteria for giant cell arteritis (GCA) have been recently published. The aim of this study is to investigate whether the score obtained by summing clinical and laboratory items and the fulfillment of each item correlate with prognosis.
Methods: Data of GCA patients from centres belonging to the Italian Society of Rheumatology Vasculitis Group were retrospectively reviewed. Baseline clinical/laboratory items included in the 2022 GCA classification criteria were retrieved and summed to obtain a total score (from 0 to 16). Therapy-related complications, disease-related outcomes and need for disease-modifying drug (DMARD) introduction at baseline (only for visual loss [VL]), at 12 months and at 60 months were evaluated. Univariate and multivariate logistic analyses were performed.
Results: 873 patients (mean score, 8.1 ± 3.3; mean items fulfilled per-patient, 4.2 ± 1.6) were included. Follow-up data were available for all patients at 12 months and for 467 (53.4%) patients at 60 months. At GCA onset, 165 (18.9%) patients had VL. At 12 and 60 months, 41 (4.7%) and 28 (6.0%) patients developed ascending aorta aneurysm (AAA), 86 (9.9%) and 45 (9.6%) patients suffered from osteoporotic fractures (OF), 49 (5.6%) and 19 (4.1%) patients developed diabetes, respectively. 331 (38%) and 224 (48.0%) patients were prescribed ≥1 DMARD within 12 and 60 months, respectively.
At univariate analysis, a higher score (excluding 'VL') was associated with VL (OR 1.551 [95%CI 1.439-1.672], p< 0.0001). A higher score was associated with AAA (OR 0.769 [0.687-0.860], p=0.0012; 0.814 [0.718-0.923], p=0.0014) at 12 and 60 months, OF (OR 1.102 [1.029-1.180], p=0.0057, 1.171 [1.064-1.290], p=0.0013) at 12 and 60 months, diabetes at 60 months (OR 0.856 [0.740-0.990], p=0.0364), and need for DMARD introduction at 12 (OR 0.948 [0.909-0.989], p=0.0135) and 60 months (OR 0.902 [0.853-0.955], p=0.0003). A score < 7 was associated with DMARD introduction at both timepoints (Figure).
At multivariate analysis, jaw/tongue claudication and temporal artery abnormality were directly associated with whereas polymyalgic symptoms and CRP ≥10 mg/L were inversely associated with VL. Jaw/tongue claudication was associated with a lower risk of AAA and higher risk of OF at 12 months and with a higher risk of OF at 60 months; headache with a lower risk of AAA at 60 months and VL with a higher risk of OF at 12 months (Table).
Conclusion: Considering only clinical and laboratory items, a higher score obtained from the 2022 GCA classification criteria is positively associated with VL and OF, and negatively with AAA and diabetes. A score < 7 is associated with a higher probability of receiving a DMARD. Cranial symptoms increase the risk of VL and OF but reduce the risk of AAA. PMR symptoms and high CRP levels are protective for VL.
Figure legend. Cumulative incidence of DMARD introduction in patients with a score <7 (blue line) and in patients with a score ≥7 (red line) at 12 (A) and 60 months (B).
Table legend. Univariate and multivariate logistic analyses evaluating the association of each item with different outcomes.
A. Tomelleri: Novartis, 1; C. Campochiaro: Boehringer Ingelheim, 1, 6, Janssen, 1, 6, Novartis, 1, 6; F. Muratore: None; S. Monti: CSL Vifor, 6; N. Farina: None; C. Marvisi: None; E. Galli: None; A. Milanesi: None; N. Viapiana: None; A. Berti: None; R. Bortolotti: None; M. Bond: AbbVie/Abbott, 5; R. Padoan: GlaxoSmithKlein(GSK), 6; M. Felicetti: None; F. Schiavon: None; C. Nannini: None; F. Cantini: None; A. Giollo: Eli Lilly, 6, galapagos, 2, 6, Novartis, 2, Sandoz, 2; M. Rossini: None; E. Conticini: None; B. Frediani: None; F. Conti: None; R. Priori: None; M. Sebastiani: None; G. Cassone: None; L. Quartuccio: None; E. Treppo: None; S. Bettio: None; A. Hoxha: None; M. Lovisotto: None; G. Emmi: AstraZeneca, 2, Boehringer-Ingelheim, 2, GlaxoSmithKlein(GSK), 2, Novartis, 2, Sanofi, 2, Sobi, 2; i. mattioli: None; P. Leccese: None; R. Caporali: AbbVie, 2, 6, Amgen, 2, 6, BMS, 2, 6, Celltrion, 2, 6, Fresenius Kabi, 2, Galapagos, 2, 6, Janssen, 2, 6, Lilly, 2, 6, MSD, 2, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 2, Sandoz, 2, 6, UCB, 2, 6; L. Argolini: None; R. Foti: None; E. Visalli: None; M. Colaci: None; C. Montecucco: None; L. Dagna: AbbVie/Abbott, 2, AstraZeneca, 2, biogen, 2, Boehringer-Ingelheim, 2, Bristol-Myers Squibb(BMS), 2, 5, Eli Lilly, 2, galapagos, 2, GlaxoSmithKlein(GSK), 2, Janssen, 2, Kiniksa Pharmaceuticals, 2, Novartis, 2, 6, Pfizer, 2, 5, SOBI, 2, 5, 6; C. Salvarani: CSL Vifor, 1, 2, 6, Eli Lilly, 1, 2, 6.
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