TY - JOUR
T1 - The proposed role of ultrasound in the management of giant cell arteritis in routine clinical practice
AU - Monti, Sara
AU - Floris, Alberto
AU - Ponte, Cristina B.
AU - Schmidt, Wolfgang A.
AU - Diamantopoulos, Andreas P.
AU - Pereira, Claudio
AU - Vaggers, Sophie
AU - Luqmani, Raashid A.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objective: To develop and explore a protocol for using colour duplex sonography (CDS) in the routine care of GCA.Methods: We tested CDS of temporal arteries and axillary arteries (AXs) on consecutive patients with suspected or established GCA, between July 2014 and September 2016.Results: We assessed 293 patients [age 72 (10), female/male 196/97], of whom 118 had clinically confirmed GCA. Seventy-three percent of patients had already received high-dose glucocorticoids (GCs) for 17 (33) days. Among new referrals with <7 days of GC treatment (n = 55), the sensitivity of CDS was 63.3% (95% CI: 44%, 80%), specificity 100% (95% CI: 83%, 100%), positive predictive value 100% and negative predictive value 64.5% (95% CI: 53%, 74%). Sensitivity rose to 81.8% in patients with jaw claudication and high inflammatory markers. During the observation period, the rate of temporal artery biopsies decreased from 72 (42%) to 36 (25%) (P = 0.002). CDS was positive in 21% of 89 follow-up scans in asymptomatic individuals, compared with 37% in patients experiencing clinical flares. Over time, the number of halos reduced; only new or flaring patients showed a halo in four or more sites. The diameter of axillary halos reduced from referral [1.6 (0.4) mm] to follow-up [1.4 (0.2) mm, P = 0.01] or flares [1.4 (0.2) mm, P = 0.02].Conclusion: CDS provides high positive predictive value for diagnosing GCA and allows for a significant reduction in temporal artery biopsies. We explored the role of CDS in detecting flares and demonstrated a relationship to the extent of the distribution of halos, but not to their size.
AB - Objective: To develop and explore a protocol for using colour duplex sonography (CDS) in the routine care of GCA.Methods: We tested CDS of temporal arteries and axillary arteries (AXs) on consecutive patients with suspected or established GCA, between July 2014 and September 2016.Results: We assessed 293 patients [age 72 (10), female/male 196/97], of whom 118 had clinically confirmed GCA. Seventy-three percent of patients had already received high-dose glucocorticoids (GCs) for 17 (33) days. Among new referrals with <7 days of GC treatment (n = 55), the sensitivity of CDS was 63.3% (95% CI: 44%, 80%), specificity 100% (95% CI: 83%, 100%), positive predictive value 100% and negative predictive value 64.5% (95% CI: 53%, 74%). Sensitivity rose to 81.8% in patients with jaw claudication and high inflammatory markers. During the observation period, the rate of temporal artery biopsies decreased from 72 (42%) to 36 (25%) (P = 0.002). CDS was positive in 21% of 89 follow-up scans in asymptomatic individuals, compared with 37% in patients experiencing clinical flares. Over time, the number of halos reduced; only new or flaring patients showed a halo in four or more sites. The diameter of axillary halos reduced from referral [1.6 (0.4) mm] to follow-up [1.4 (0.2) mm, P = 0.01] or flares [1.4 (0.2) mm, P = 0.02].Conclusion: CDS provides high positive predictive value for diagnosing GCA and allows for a significant reduction in temporal artery biopsies. We explored the role of CDS in detecting flares and demonstrated a relationship to the extent of the distribution of halos, but not to their size.
KW - colour duplex sonography
KW - diagnosis
KW - flare
KW - follow-up
KW - giant cell arteritis
KW - routine clinical care
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U2 - 10.1093/rheumatology/kex341
DO - 10.1093/rheumatology/kex341
M3 - Article
C2 - 29045738
AN - SCOPUS:85039053218
VL - 57
SP - 112
EP - 119
JO - Rheumatology
JF - Rheumatology
SN - 1462-0324
IS - 1
ER -