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Peter Engholm Hjort,1,2,* Philip Therkildsen,1,2,* Berit Dalsgaard Nielsen,1– 3 Ib Tønder Hansen,1,2 Mette Nørgaard,2,4 Annette de Thurah,1,2 Ellen-Margrethe Hauge1,2 1Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 3Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark; 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark*These authors contributed equally to this workCorrespondence: Philip TherkildsenDepartment of Rheumatology, Aarhus University Hospital, Aarhus, DenmarkEmail philther@rm.dkPurpose: To investigate the positive predictive value (PPV) of the giant cell arteritis (GCA) diagnosis in the Danish National Patient Registry (DNPR).Patients and Methods: A total of 293 patients aged ≥ 50 years with a first-time diagnosis of GCA in the DNPR between January 2012 and December 2017 were included. Patients were sampled from two secondary and one tertiary care hospitals in the Central Region Denmark. Two independent investigators (PH & PT) reviewed all medical files, including medical records, treatment, biochemistry, histopathology and imaging, and either confirmed or dismissed the diagnosis of GCA. In case of disagreement, a consensus agreement was reached. Sub-analyses including number of redeemed prescriptions performed temporal artery biopsies (TABs), and number of GCA-related hospital contacts were performed.Results: We confirmed the diagnosis of GCA in 183/293 patients resulting in a PPV of 62% (95% CI: 57– 68). In patients with ≥ 3 redeemed prescriptions of glucocorticoids (GCs), we confirmed the diagnosis in 166/214 resulting in a PPV of 78% (95% CI: 71– 83). In patients with ≥ 3 redeemed prescriptions of GCs and ≥ 3 GCA-related hospital contacts, we confirmed the diagnosis in 88/95 resulting in a PPV of 93% (95% CI: 85– 96); however, this only included 88/183 confirmed GCA patients.Conclusion: This is the first study to validate the diagnostic code of GCA in the DNPR. The overall PPV of GCA in the DNPR was 62%. Requiring redeemed prescriptions of GCs and/or GCA-related hospital contacts increase the PPV, but also excludes a significant number of GCA patients.Keywords: rheumatology, giant cell arteritis, validation, positive predictive value, Danish National Patient Registry

Andreas Bugge Tinggaard,1 Annette de Thurah,2 Ina Trolle Andersen,3 Anders Hammerich Riis,3 Josephine Therkildsen,1 Simon Winther,4 Ellen-Margrethe Hauge,2 Morten Bøttcher1 1Department of Cardiology, Hospital Unit West, Herning, Denmark; 2Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 4Department of Cardiology, Aarhus University Hospital, Aarhus, DenmarkCorrespondence: Andreas Bugge Tinggaard Tel +0045 30272717Email andreas.bugge@midt.rm.dkPurpose: To examine the occurrence and severity of coronary artery disease (CAD) in patients with rheumatoid arthritis (RA) compared to non-RA patients in a population referred for coronary computed tomography angiography (CTA) due to chest pain.Patients and Methods: In this cross-sectional study, 46,210 patients from a national CTA database were included. Patients with RA were stratified on serology, treatment with conventional synthetic or biological disease-modifying antirheumatic drugs (DMARDs), and the need for relapse or flare treatment with intraarticular or -muscular glucocorticoid injections (GCIs). Primary outcomes were coronary artery calcium score (CACS) > 0 and CACS ≥ 400, and secondary outcome was obstructive CAD. Associations between RA and outcomes were examined using logistic regression and results were adjusted for age, sex, cardiovascular risk factors and comorbidities.Results: A total of 395 (0.9%) RA patients were identified. In overall RA, crude odds ratio (OR) for having CACS > 0 was 1.48 (1.21– 1.82) and 1.52 (1.15– 2.01) for CACS ≥ 400, whereas adjusted ORs were 1.08 (0.86– 1.36) and 1.21 (0.89– 1.65), respectively. Seropositive RA patients had adjusted OR of 1.16 (0.89– 1.50) for CACS > 0 and 1.37 (0.98– 1.90) for CACS ≥ 400. Patients who had received ≥ 1 GCI in the period of 3 years prior to the CTA had an adjusted OR of 1.37 (0.94– 2.00) for having CACS > 0 and 1.46 (0.92– 2.31) for CACS ≥ 400.Conclusion: This is the first large-scale, CTA-based study examining the occurrence and severity of CAD in RA patients with symptoms suggestive of cardiovascular disease. A higher prevalence of coronary artery calcification was found in RA patients. After adjusting for age, sex, cardiovascular risk factors and comorbidities, the tendency was less pronounced. We found a trend for increased coronary calcification in RA patients being seropositive or needing treatment with GCI for a relapse or flare.Keywords: rheumatoid arthritis, computed tomography angiography, coronary artery disease, coronary artery calcium score, cross-sectional