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

Authors

  • Gene G. Hunder MD,

    Chair, Corresponding author
    1. Mayo Clinic, Rochester, MN Subcommittee on Classification of Vasculitis
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Daniel A. Bloch PhD,

    Corresponding author
    1. Stanford University, Stanford, CA
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Beat A. Michel MD,

    Corresponding author
    1. Rheumaklinik Universitätsspital, Zurich, Switzerland
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Mary Betty Stevens MD,

    Corresponding author
    1. Johns Hopkins University, Baltimore, MD
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • William P. Arend MD,

    Corresponding author
    1. University of Colorado Health Science Center, Denver, CO
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Leonard H. Calabrese DO,

    Corresponding author
    1. Cleveland Clinic Foundation, Cleveland, OH
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Steven M. Edworthy MD,

    Corresponding author
    1. University of Calgary, Calgary, Alberta, Canada
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Anthony S. Fauci MD,

    Corresponding author
    1. NIAID, NIH, Bethesda, MD
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Randi Y. Leavitt MD, PHD,

    Corresponding author
    1. NIA1D, NIH, Bethesda, MD
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • J. T. Lie MD,

    Corresponding author
    1. Mayo Clinic, Rochester, MN
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Robert W. Lightfoot Jr MD,

    Corresponding author
    1. University of Kentucky, Lexington, KY
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Alfonse T. Masi MD, DRPH,

    Corresponding author
    1. University of Illinois College of Medicine, Peoria, IL
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Dennis J. McShane MD,

    Corresponding author
    1. Stanford University, Stanford, CA
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • John A. Mills MD,

    Corresponding author
    1. Massachusetts General Hospital, Boston, MA
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Stanley L. Wallace MD,

    Corresponding author
    1. SUNY Downstate Medical Center, Brooklyn, NY (Dr. Wallace is deceased)
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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  • Nathan J. Zvaifler MD

    Corresponding author
    1. University of California, San Diego, San Diego, CA
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480, Atlanta, GA 30329
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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%.

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