Utilization of the Revised American College of Rheumatology (rACR) Scoring to Avoid Unnecessary Temporal Artery Biopsies—A Case Series

Abstract

Introduction: The American College of Rheumatology (ACR) criteria, and more recently the revised ACR criteria (rACR), are a scoring system developed to aid in the diagnosis of giant cell arteritis (GCA). Our aim was to investigate the value of the non-biopsy criteria of the original ACR criteria and rACR criteria to predict GCA, and investigate the utilization of such scores to avoid biopsy when a very high or very low likelihood of a positive temporal artery biopsy TAB was predicted. Method: We conducted a retrospective cohort study of 59 patients undergoing TAB from 2013 to 2017 in Beaumont Hospital, a tertiary referral centre in Dublin, Ireland. Demographic data, biochemical results, presenting features, and histology results were collected and collated. Results: Data were analysed from 53 patients and ACR scores were compiled. Seventeen scored < 3 and thirty-six scored 3–5. All 11 positive biopsies were in the 3–5 score range. Forty-five patients were analysed with rACR scores. Eight were excluded due to not meeting the inclusion criteria. Of the 11 positive biopsies, 2 were in the 3–4 score range, and 9 were in the ≥ 5 score range. In the ACR method, 36% of all biopsies scored as low-risk pre-biopsy. In the rACR method, 84.4% of all biopsies scored in the low- and intermediate-risk group pre-biopsy and 15.6% of all biopsies scored in the high-risk group pre-biopsy. Conclusions: This study illustrates the potential value of the rACR scoring system as a useful tool to categorize patients according to risk with a view to avoiding unnecessary TAB. The data suggest that a TAB has a helpful role in low- and intermediate-risk groups but is of minimal benefit in the high-risk group.

Comparison of classification criteria for giant cell arteritis

“…В нашем исследовании показатель AUC был ниже -0,723 для критериев 1990 года и 0,770 для пересмотренных критериев. Разница в данных, вероятно, обусловлена меньшим количеством биопсий височной артерии в нашей выборке [20]. Классификационные критерии ACR/EULAR 2022 г. были валидированы в клиническом исследовании у 238 пациентов с ГКС и 213 контрольных пациентов [12].…”

Zoledronate-Induced Large Vessel Vasculitis Diagnosed by PET/CT

“…The diagnosis of GCA is commonly based on a scoring system developed by the American College of Rheumatology (ACR) in 1990 and revised in 2016 [10]. Temporal artery biopsy has been considered the gold standard for a long time, but negative biopsy results can be seen in up to half of cases due to non-involvement of the temporal artery or skip lesions [7].…”