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FRI0219 Involvement of supra-aortic vessels in giant cell arteritis diagnosed by color duplex ultrasonography
  1. A.P. Diamantopoulos,
  2. H. Hetland,
  3. G. Myklebust,
  4. G. Haugeberg
  1. Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway

Abstract

Background The highest incidence of giant cell arteritis (GCA) worldwide has been reported from Southern Norway [1]. Aortic branch involvement [i.e. large vessel vasculitis (LVV)] has been reported to be present in 29-32% of GCA patients [2,3]. In these reports, LVV involvement was more often seen in females, but was not associated with high levels of inflammation or jaw claudicating [2,3].

Objectives To study the frequency of LVV in patients with GCA from a high endemic area using color duplex ultrasonography (CDUS).

Methods Between 1 January 2010 and 31 December 2011, we consecutively identified individuals referred to our department who had both a clinical history suspicious of GCA and CDUS findings consistent with GCA. In these patients (28 cases), clinical and laboratory data were registered. Temporal artery biopsy was performed in the majority of the patients (22 cases). A Siemens Acuson Antares ultrasound system with two frequency probes of 7-14 MHz and 4-8 MHz and a color Doppler frequency of >6 MHz was used to access the supra-aortic vessels. CDUS was considered positive when a homogeneous hypoechoic thickness of intima-media complex >1.5 mm in carotids and >1mm in the rest of supra-aortic vessels in transverse and longitudinal view was observed.

Results We identified 28 patients (7 males, 21 females) with a mean age of 74 years. Twenty-three patients fulfilled the ACR classification criteria for GCA and 15 had a positive temporal artery biopsy. LVV involvement was found in 25% of the patients (4 males, 3 females, mean age 73 years) on CDUS. LVV was observed more often in males compared to patients without LVV (57.2% vs. 14.2, p<0.02) and LVV patients had more often fever (57.2% vs. 14.2%, p<0.02), weight loss more than 2 kg (57.2% vs. 9.5%, p<0.007) and lower levels of inflammation [CRP >100 mg/dl (0% vs. 19%)]. Fewer patients with LVV fulfilled the ACR GCA classification criteria (57.2%, vs. 90.5% p<0.04). No difference was seen between patients with LVV and those without LVV with respect to jaw claudication (14.3% vs. 47.6%, p<0.1), new onset headache (42.8vs. 76.2%, p<0.1), polymyalgia rheumatica (28.5% vs. 42.8%, p<0.5), positive temporal artery biopsy (100% vs. 59%, p<0.08) and visual manifestations (28.5% vs. 28.6%, p<0.9).

Conclusions The prevalence of LVV involvement in GCA patients from Southern Norway is comparable to reports from other geographic areas. However, we found more men than women to have LVV GCA than previously reported. Patients with GCA and CDUS detected LVV had more often constitutional symptoms e.g. fever and weight loss than patients with classic GCA.

  1. Haugeberg G, Paulsen PQ, Bie RB. Temporal arteritis in Vest Agder County in southern Norway: incidence and clinical findings. J Rheumatol. 2000 Nov;27(11):2624-7.

  2. Schmidt WA, Seifert A, Gromnica-Ihle E, Krause A, Natusch A. Ultrasound of proximal upper extremity arteries to increase the diagnostic yield in large-vessel giant cell arteritis. Rheumatology (Oxford). 2008 Jan;47(1):96-101.

  3. Ghinoi A, Pipitone N, Nicolini A, Boiardi L, Silingardi M, Germano G, et al. Large-vessel involvement in recent-onset giant cell arteritis: a case-control colour-Doppler sonography study. Rheumatology (Oxford). 2011 Dec 16.

Disclosure of Interest None Declared

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