Objective: To develop and validate new classification criteria for Takayasu arteritis (TAK). Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 6 phases: 1) identification of candidate criteria items, 2) collection of candidate items present at diagnosis, 3) expert panel review of cases, 4) data-driven reduction of candidate items, 5) derivation of a points-based classification score in a development data set, and 6) validation in an independent data set. Results: The development data set consisted of 316 cases of TAK and 323 comparators. The validation data set consisted of an additional 146 cases of TAK and 127 comparators. Age ≤60 years at diagnosis and imaging evidence of large-vessel vasculitis were absolute requirements to classify a patient as having TAK. The final criteria items and weights were as follows: female sex (+1), angina (+2), limb claudication (+2), arterial bruit (+2), reduced upper extremity pulse (+2), reduced pulse or tenderness of a carotid artery (+2), blood pressure difference between arms of ≥20 mm Hg (+1), number of affected arterial territories (+1 to +3), paired artery involvement (+1), and abdominal aorta plus renal or mesenteric involvement (+3). A patient could be classified as having TAK with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the model area under the curve was 0.97 (95% confidence interval [95% CI] 0.94–0.99) with a sensitivity of 93.8% (95% CI 88.6–97.1%) and specificity of 99.2% (95% CI 96.7–100.0%). Conclusion: The 2022 American College of Rheumatology/EULAR classification criteria for TAK are now validated for use in research.
2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis / Grayson, P. C.; Ponte, C.; Suppiah, R.; Robson, J. C.; Gribbons, K. B.; Judge, A.; Craven, A.; Khalid, S.; Hutchings, A.; Danda, D.; Luqmani, R. A.; Watts, R. A.; Merkel, P. A.; Gatenby, P.; Hill, C.; Ranganathan, D.; Kronbichler, A.; Blockmans, D.; Barra, L.; Carette, S.; Pagnoux, C.; Dhindsa, N.; Fifi-Mah, A.; Khalidi, N.; Liang, P.; Milman, N.; Pineau, C.; Tian, X.; Wang, G.; Wang, T.; Zhao, M. -H.; Tesar, V.; Baslund, B.; Hammam, N.; Shahin, A.; Pirila, L.; Putaala, J.; Hellmich, B.; Henes, J.; Holle, J.; Lamprecht, P.; Moosig, F.; Neumann, T.; Schmidt, W.; Sunderkoettey, C.; Szekanecz, Z.; Danda, D.; Das, S.; Gupta, R.; Rajasekhar, L.; Sharma, A.; Wagh, S.; Clarkson, M.; Molloy, E.; Salvarani, C.; Schiavon, F.; Tombetti, E.; Vaglio, A.; Amano, K.; Arimura, Y.; Dobashi, H.; Fujimoto, S.; Harigai, M.; Hirano, F.; Hirahashi, J.; Honma, S.; Kawakami, T.; Kobayashi, S.; Kono, H.; Makino, H.; Matsui, K.; Muso, E.; Suzuki, K.; Ikeda, K.; Takeuchi, T.; Tsukamoto, T.; Uchida, S.; Wada, T.; Yamada, H.; Yamagata, K.; Yumura, W.; Lai, K. S.; Flores-Suarez, L. F.; Hinojosa-Azaola, A.; Rutgers, B.; Tak, P. -P.; Grainger, R.; Quincey, V.; Stamp, L.; Suppiah, R.; Besada, E.; Diamantopoulos, A.; Sznajd, J.; Azevedo, E.; Geraldes, R.; Rodrigues, M.; Santos, E.; Song, Y. -W.; Moiseev, S.; Hocevar, A.; Cid, M. C.; Moreno, X. S.; Atukorala, I.; Berglin, E.; Mohammed, A.; Segelmark, M.; Daikeler, T.; Direskeneli, H.; Hatemi, G.; Kamali, S.; Karadag, O.; Pehlevan, S.; Adler, M.; Basu, N.; Bruce, I.; Chakravarty, K.; Dasgupta, B.; Flossmann, O.; Gendi, N.; Hassan, A.; Hoyles, R.; Jayne, D.; Jones, C.; Klocke, R.; Lanyon, P.; Laversuch, C.; Luqmani, R.; Robson, J.; Magliano, M.; Mason, J.; Maw, W. W.; Mcinnes, I.; Mclaren, J.; Morgan, M.; Morgan, A.; Mukhtyar, C.; O'Riordan, E.; Patel, S.; Peall, A.; Robson, J.; Venkatachalam, S.; Vermaak, E.; Menon, A.; Watts, R.; Yee, C. -S.; Albert, D.; Calabrese, L.; Chung, S.; Forbess, L.; Gaffo, A.; Gewurz-Singer, O.; Grayson, P.; Liang, K.; Matteson, E.; Merkel, P. A.; Rhee, R.; Springer, J.; Sreih, A.. - In: ARTHRITIS & RHEUMATOLOGY. - ISSN 2326-5191. - 74:12(2022), pp. 1872-1880. [10.1002/art.42324]
2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis
Salvarani C.;
2022
Abstract
Objective: To develop and validate new classification criteria for Takayasu arteritis (TAK). Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 6 phases: 1) identification of candidate criteria items, 2) collection of candidate items present at diagnosis, 3) expert panel review of cases, 4) data-driven reduction of candidate items, 5) derivation of a points-based classification score in a development data set, and 6) validation in an independent data set. Results: The development data set consisted of 316 cases of TAK and 323 comparators. The validation data set consisted of an additional 146 cases of TAK and 127 comparators. Age ≤60 years at diagnosis and imaging evidence of large-vessel vasculitis were absolute requirements to classify a patient as having TAK. The final criteria items and weights were as follows: female sex (+1), angina (+2), limb claudication (+2), arterial bruit (+2), reduced upper extremity pulse (+2), reduced pulse or tenderness of a carotid artery (+2), blood pressure difference between arms of ≥20 mm Hg (+1), number of affected arterial territories (+1 to +3), paired artery involvement (+1), and abdominal aorta plus renal or mesenteric involvement (+3). A patient could be classified as having TAK with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the model area under the curve was 0.97 (95% confidence interval [95% CI] 0.94–0.99) with a sensitivity of 93.8% (95% CI 88.6–97.1%) and specificity of 99.2% (95% CI 96.7–100.0%). Conclusion: The 2022 American College of Rheumatology/EULAR classification criteria for TAK are now validated for use in research.
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