scholarly journals The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

2016 ◽  
Vol 20 (90) ◽  
pp. 1-238 ◽  
Author(s):  
Raashid Luqmani ◽  
Ellen Lee ◽  
Surjeet Singh ◽  
Mike Gillett ◽  
Wolfgang A Schmidt ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Systemic Vasculitis ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Health Gain ◽  
Temporal Artery Biopsy ◽  
Test Results

Background Giant cell arteritis (GCA) is a relatively common form of primary systemic vasculitis, which, if left untreated, can lead to permanent sight loss. We compared ultrasound as an alternative diagnostic test with temporal artery biopsy, which may be negative in 9–61% of true cases. Objective To compare the clinical effectiveness and cost-effectiveness of ultrasound with biopsy in diagnosing patients with suspected GCA. Design Prospective multicentre cohort study. Setting Secondary care. Participants A total of 381 patients referred with newly suspected GCA. Main outcome measures Sensitivity, specificity and cost-effectiveness of ultrasound compared with biopsy or ultrasound combined with biopsy for diagnosing GCA and interobserver reliability in interpreting scan or biopsy findings. Results We developed and implemented an ultrasound training programme for diagnosing suspected GCA. We recruited 430 patients with suspected GCA. We analysed 381 patients who underwent both ultrasound and biopsy within 10 days of starting treatment for suspected GCA and who attended a follow-up assessment (median age 71.1 years; 72% female). The sensitivity of biopsy was 39% [95% confidence interval (CI) 33% to 46%], which was significantly lower than previously reported and inferior to ultrasound (54%, 95% CI 48% to 60%); the specificity of biopsy (100%, 95% CI 97% to 100%) was superior to ultrasound (81%, 95% CI 73% to 88%). If we scanned all suspected patients and performed biopsies only on negative cases, sensitivity increased to 65% and specificity was maintained at 81%, reducing the need for biopsies by 43%. Strategies combining clinical judgement (clinician’s assessment at 2 weeks) with the tests showed sensitivity and specificity of 91% and 81%, respectively, for biopsy and 93% and 77%, respectively, for ultrasound; cost-effectiveness (incremental net monetary benefit) was £485 per patient in favour of ultrasound with both cost savings and a small health gain. Inter-rater analysis revealed moderate agreement among sonographers (intraclass correlation coefficient 0.61, 95% CI 0.48 to 0.75), similar to pathologists (0.62, 95% CI 0.49 to 0.76). Limitations There is no independent gold standard diagnosis for GCA. The reference diagnosis used to determine accuracy was based on classification criteria for GCA that include clinical features at presentation and biopsy results. Conclusion We have demonstrated the feasibility of providing training in ultrasound for the diagnosis of GCA. Our results indicate better sensitivity but poorer specificity of ultrasound compared with biopsy and suggest some scope for reducing the role of biopsy. The moderate interobserver agreement for both ultrasound and biopsy indicates scope for improving assessment and reporting of test results and challenges the assumption that a positive biopsy always represents GCA. Future work Further research should address the issue of an independent reference diagnosis, standards for interpreting and reporting test results and the evaluation of ultrasound training, and should also explore the acceptability of these new diagnostic strategies in GCA. Funding The National Institute for Health Research Health Technology Assessment programme.

scholarly journals Response to: ‘The role of temporal artery biopsy in patients with giant cell arteritis is debated’ by Moiseev et al

2018 ◽  
Vol 78 (4) ◽  
pp. e32-e32 ◽  
Author(s):  
Christian Dejaco ◽  
Sofia Ramiro ◽  
Christina Duftner ◽  
Wolfgang A Schmidt
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
Temporal Artery Biopsy

scholarly journals Polymialgia Rheumatica, Giant Cell Arteritis or Both?

2018 ◽  
Vol 15 (6) ◽  
pp. 51-58
Author(s):  
Adina Cociorvei ◽  
Mădălina Ababei
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Arteritis ◽  
Morning Stiffness ◽  
Systemic Vasculitis ◽  
Diagnostic Algorithm ◽  
Signs And Symptoms ◽  
Temporal Artery ◽  
Clinical Suspicion ◽  
Temporal Artery Biopsy

AbstractGiant cell arteritis (GCA), or temporal arteritis, is the most common systemic vasculitis, and the greatest risk factor for developing GCA is aging. The disease almost never occurs before age 50, and its incidence rises steadily thereafter, peaking between ages 70 to 79, the risk of development being two times higher in women.Polymialgia rheumatica (PMR) is an inflammatory rheumatic condition characterized clinically by aching and morning stiffness at the shoulders, hip girdle, and neck. PMR is almost exclusively a disease of adults over the age of 50, with a prevalence that increases progressively with advancing age. The peak incidence of PMR occurs between ages 70 and 80, the same as in the case ofGCA. PMRis 2-3 times more common in women than in men.PMR is two to three times more common than GCA and occurs in about 50% of patients with GCA. The percentage of patients with PMR who experience GCA at some point varies widely in reported series ranging from 5 to 30 percent. PMR can precede, accompany or follow GCA. The diagnostic in the case of PMR is made first of all on clinical features, in the patients in whom another disease to explain the findings is not present. For GCA we must follow the diagnostic algorithm presented below (figure 1) and keep in mind that a negative result for temporal artery biopsy does not exclude the diagnostic if clinical suspicion of GCA is highWe present the case of a 81 year-old male with signs and symptoms from both conditions, PMR and GCA.

scholarly journals Stroke and Internal Carotid Dissection as the First Manifestation of Giant Cell Arteritis: A Case Report

2021 ◽  
Author(s):  
Leila Hashami ◽  
Arsh Haj Mohamad Ebrahim Ketabforoush
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Internal Carotid ◽  
Systemic Vasculitis ◽  
Brain Mri ◽  
Artery Dissection ◽  
Temporal Artery Biopsy ◽  
Large Artery ◽  
Carotid Dissection ◽  
The Right

Abstract Introduction: Giant Cell Arteritis (GCA) is a systemic vasculitis that involves medium-sized and larger arteries.GCA rarely can affect the brain-arteries, resulting in ischemic strokes and transient ischemic attacks, whereby the most affected region is vertebrobasilar. Also, it's very unusual that cocurate with large artery dissections. We describe a patient with anterior brain territory stroke and right internal carotid dissection as the first manifestation of GCA.Case report: A 51-year-old man was presented with sudden onset of right-side blurred vision, frozen movements, and ptosis in the right eye and left side paresis. There was a history of right-sided frontotemporal headache, diabetes mellitus, and dyslipidemia. The Laboratory tests show erythrocyte sedimentation rate (ESR)=90, C-reactive protein (CRP)=15mg/L. CT scan and brain MRI indicated an acute ischemic infarction in the right frontal region. CT-Angiography has shown internal carotid artery dissection. Due to the presentation and lab tests, we started Methylprednisolone 1 gr for treating GCA, and temporal artery biopsy was positive for GCA in pathology findings. After ten days, inflammatory markers were reduced (ESR:40). Besides improving headaches, there was no significant change in eye deficits and reduction of left limb's force.Conclusion: Due to the noisy symptoms in patients with Stroke and carotid dissection, the diagnosis of GCA may be neglected as an underlying cause. The association of high CRP levels and the rate of ESR with Stroke, although nonspecific, should draw some attention to vasculitis, topped by GCA.

scholarly journals Successful Treatment of a Patient with Giant Cell Vasculitis (Horton Arteritis) with Tocilizumab a Humanized Anti-Interleukin-6 Receptor Antibody

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Alfredomaria Lurati ◽  
Luca Bertani ◽  
Katia Angela Re ◽  
Mariagrazia Marrazza ◽  
Daniela Bompane ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Successful Treatment ◽  
Interleukin 6 ◽  
Systemic Vasculitis ◽  
Temporal Artery ◽  
Temporal Artery Biopsy ◽  
Receptor Antibody ◽  
Large Size ◽  
Interleukin 6 Receptor

Giant cell arteritis (GCA) is the most common form of systemic vasculitis in adults, affecting preferentially medium-large size arteries. Here we report a case of a female with a diagnosis of GCA based on temporal artery biopsy, successfully treated with tocilizumab, a humanized anti-interleukin-6 receptor antibody.

scholarly journals The role of temporal artery biopsy in patients with giant-cell arteritis is debated

2018 ◽  
Vol 78 (4) ◽  
pp. e31-e31 ◽  
Author(s):  
Sergey V Moiseev ◽  
Ilya Smitienko ◽  
Nikolay Bulanov ◽  
Pavel I Novikov
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
Temporal Artery Biopsy

scholarly journals Will imaging change the diagnosis and management of giant cell arteritis?

2019 ◽  
Vol 57 (4) ◽  
pp. 341-344
Author(s):  
Andra Chiriac ◽  
Camelia Badea ◽  
Cristian Băicuș
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Systemic Vasculitis ◽  
Positive Likelihood Ratio ◽  
Temporal Artery ◽  
Temporal Artery Biopsy ◽  
Positive Diagnosis ◽  
Clinical Evolution ◽  
Acr Criteria ◽  
Test Probability

Abstract Giant cell arteritis is a common systemic vasculitis affecting the elderly, with maximum prevalence in the 7th decade of age, targeting aortic derived medium and large vessels of the neck and head. Diagnosis is established on a biopsy specimen of the temporal artery wall, through pathological confirmation of panarteritis, typically characterized by mononuclear cell infiltrate, with the 1990 ACR criteria often used in clinical practice. We present the case of a patient with a new onset headache and systemic inflammation, who did not fulfil the classical diagnostic criteria, nor did the temporal artery biopsy (TAB) provide a positive result. However, the ultrasonographical features, clinical evolution and response to corticosteroid therapy confirmed the diagnosis. This patient had bilateral presence of the halo sign on color duplex ultrasonography (CDUS), cited as a highly specific feature, when compared to the ACR criteria as a standard reference. We employed its positive likelihood-ratio (LR+) of 43 as previously estimated, while considering a low pre-test probability for a positive diagnosis (15%), to calculate a post-test probability of 88%, leading to our decision to treat him as having giant cell arteritis. Remission of the headache and rebound phenomena when tapered off steroid therapy substantially contributed to the positive diagnosis, underlining the importance of future studies needing to use clinical evolution as a reference standard.

scholarly journals Giant Cell Arteritis: Navigating Beyond the Headache

EMJ Radiology ◽  
2021 ◽  
Author(s):  
Patricia Harkins ◽  
Richard Conway
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Systemic Vasculitis ◽  
False Negative ◽  
Temporal Artery ◽  
Medical Emergency ◽  
Temporal Artery Biopsy ◽  
Negative Results ◽  
False Negative Results ◽  
Diagnostic Modalities

Giant cell arteritis (GCA) is the most common systemic vasculitis. In the past two decades there have been significant advancements in our understanding of the pathophysiological mechanisms underlying the disease, and consequently the management of GCA is evolving. GCA is a medical emergency because when left untreated it can lead to devastating complications including irreversible visual loss. Thus, prompt diagnosis is imperative to ensure appropriate treatment and prevent ischaemic events. However, uncertainty remains over diagnostic pathways, including appropriate modalities and standardisation of findings. Temporal artery biopsy has been considered the gold standard diagnostic test but has significant limitations in terms of false negative results. In recent times, several new diagnostic modalities have been proposed in GCA including temporal artery ultrasound, CT angiography, magnetic resonance angiography, and PET. In this paper, the authors review the advantages and limitations of current diagnostic modalities in GCA.

scholarly journals The Thromboembolic Risk in Giant Cell Arteritis: A Critical Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
A. Guida ◽  
A. Tufano ◽  
P. Perna ◽  
P. Moscato ◽  
M. T. De Donato ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Vision Loss ◽  
Systemic Vasculitis ◽  
Granulomatous Inflammation ◽  
Cardiovascular Prevention ◽  
Sudden Onset ◽  
New Drugs ◽  
Rheumatological Disease

Giant cell arteritis is a systemic vasculitis characterized by granulomatous inflammation of the aorta and its main vessels. Cardiovascular risk, both for arterial and venous thromboembolism, is increased in these patients, but the role of thromboprophylaxis is still debated. It should be suspected in elderly patients suffering from sudden onset severe headaches, jaw claudication, and visual disease. Early diagnosis is necessary because prognosis depends on the timeliness of treatment: this kind of arteritis can be complicated by vision loss and cerebrovascular strokes. Corticosteroids remain the cornerstone of the pharmacological treatment of GCA. Aspirin seems to be effective in cardiovascular prevention, while the use of anticoagulant therapy is controversial. Association with other rheumatological disease, particularly with polymyalgia rheumatica is well known, while possible association with antiphospholipid syndrome is not established. Large future trials may provide information about the optimal therapy. Other approaches with new drugs, such as TNF-alpha blockades, Il-6 and IL-1 blockade agents, need to be tested in larger trials.

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