Background On ultrasound examinations large vessel vasculitis (LVV) has been reported to be present in up to 37% of giant cell arteritis (GCA) patients. In these patients, the axillary arteries are reported to be affected as high as 98% 1,2. No consensus exists on how to evaluate treatment response in LVV. Color Doppler ultrasound (CDUS) yields a high sensitivity and specificity to diagnose GCA 1.
Objectives The aim of this study was to examine if CDUS of the axillary arteries could be used to monitor treatment response in LVV-GCA.
Methods Patients with new onset or relapsing GCA (positive ultrasound of the temporal artery and typical clinical picture) and with axillary arteritis were prospectively recruited in this study. The intima media complex (IMC) thickness of the axillary artery was measured at the active disease phase (and before treatment initiation) and after the patients had achieved clinical remission. C-reactive protein (CRP) and prednisolone dose were also registered. Appropriate statistical tests were applied and p values <0.05 were considered as significant
Results Ten patients (nine females, one male) were evaluated (eight with relapsing and one with new-onset disease) with a mean (SD) age of 63 years (25). The mean start dose of prednisolone was 18.0 mg. The mean time between the active phase and remission was 3.1 months (4.1), mean CRP was reduced by 23.5 mg/dl (95% CI 7.5-39.4, p=0.01) and prednisolone by 6.5 mg (95% CI 0.9-12.1, p=0.02). On the CDUS examinations, a mean reduction of IMC thickness of 0.6 mm (95% CI 0.2-1.0, p=0.004) in the right axillary and 0.7 mm (95% CI 0.2-1.2, p=0.009) in the left axillary arteries were measured.
Conclusions CDUS of the axillary arteries seems to be a useful tool to monitor treatment response in LVV-GCA. Thus, CDUS of the large vessels has the potential to be used for the assessment of disease activity in LVV-GCA patients. These promising results have to be confirmed in larger cohorts of patients.
Diamantopoulos AP, Haugeberg G, Hetland H, Soldal DM, Bie R, Myklebust G. The diagnostic value of color Doppler ultrasonography of temporal arteries and large vessels in giant cell arteritis: A consecutive case series. Arthritis care & research 2013.
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;47:96-101.
Disclosure of Interest None declared