The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis

TLDR

The study developed classification criteria for giant cell arteritis by comparing 214 affected patients with 593 patients with other vasculitides. The traditional criteria include age ≥ 50, new headache, temporal artery tenderness or pulse loss, ESR ≥ 50 mm/h, and biopsy evidence of necrotizing arteritis with granulomatous inflammation; a classification tree added scalp tenderness and jaw/tongue claudication and omitted ESR. Using the traditional criteria, ≥3 of 5 yielded 93.5 % sensitivity and 91.2 % specificity, whereas the classification tree achieved 95.3 % sensitivity and 90.7 % specificity.

Abstract

Abstract Criteria for the classification of giant cell (temporal) arteritis were developed by comparing 214 patients who had this disease with 593 patients with other forms of vasculitis. For the traditional format classification , 5 criteria were selected: age ≥50 years at disease onset, new onset of localized headache, temporal artery tenderness or decreased temporal artery pulse, elevated erythrocyte sedimentation rate (Westergren) ≥50 mm/hour, and biopsy sample including an artery, showing necrotizing arteritis, characterized by a predominance of mononuclear cell infiltrates or a granulomatous process with multinucleated giant cells. The presence of 3 or more of these 5 criteria was associated with a sensitivity of 93.5% and a specificity of 91.2%. A classification tree was also constructed using 6 criteria. These criteria were the same as for the traditional format, except that elevated erythrocyte sedimentation rate was excluded, and 2 other variables were included: scalp tenderness and claudication of the jaw or tongue or on deglutition. The classification tree was associated with a sensitivity of 95.3% and specificity of 90.7%.