Objectives Ultrasound of temporal and axillary arteries may reveal vessel wall inflammation in patients with giant cell arteritis (GCA). We developed a ultrasound scoring system to quantify the extent of vascular inflammation and investigated its diagnostic accuracy and association with clinical factors in GCA.
Methods This is a prospective study including 89 patients suspected of having GCA, of whom 58 had a confirmed clinical diagnosis of GCA after 6 months follow-up. All patients underwent bilateral ultrasound examination of the three temporal artery (TA) segments and axillary arteries, prior to TA biopsy. The extent of vascular inflammation was quantified by (1) counting the number of TA segments and axillary arteries with a halo and (2) calculating a composite Halo Score that also incorporated the thickness of each halo.
Results Halo counts and Halo Scores showed moderate diagnostic accuracy for a clinical diagnosis of GCA. They correlated positively with systemic inflammation. When compared with the halo count, the Halo Score correlated better with C-reactive protein (CRP) levels and allowed to firmly establish the diagnosis of GCA in more patients. Higher halo counts and Halo Scores were associated with a higher risk of ocular ischaemia. They allowed to identify subgroups of patients with low risk (≤5%) and high risk of ocular ischaemia (>30%).
Conclusions Ultrasound halo scoring allows to quantify the extent of vascular inflammation in GCA. Extensive vascular inflammation on ultrasound may provide strong diagnostic confirmation and associates with ocular ischaemia in GCA.
- giant cell arteritis
- systemic vasculitis
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Handling editor Josef S Smolen
Contributors KSMvdG, WS, RAL and BD contributed to conception or design of the work. FB, AK, PG, RAL and BD contributed to acquisition of data. KSMvdG, DP, WS, RAL and BD contributed to analysis or interpretation of data. All authors were involved in drafting of the work or revising it critically for important intellectual content. All authors provided final approval of the version published. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The study was funded by the Health Technology Assessment Programme of the National Institute for Health Research (NIHR, #HTA-08/64/01).
Competing interests KSMvdG reports grants from the Mandema Stipend and the Dutch Society for Rheumatology, and personal fees from Roche, outside the submitted work. WS reports grants and personal fees from GSK, Novartis, Roche and Sanofi, and personal fees from Chugai, outside the submitted work. RAL reports grants from Arthritis UK, the Medical Research Council, the University of California San Francisco/Oxford Invention Fund, the Canadian Institutes of Health Research and The Vasculitis Foundation, grants and personal fees from GSK, and personal fees from Medpace, MedImmune and Roche, outside the submitted work. BD reports grants and personal fees from Roche, personal fees from GSK, BMS, Sanofi and AbbVie, outside the submitted work.
Patient and public involvement statement Advice on the study design was obtained from patients through PMRGCAuk. Patient representatives on the Trial Steering Committee and the Data Monitoring Committee provided important advice.
Patient consent for publication Not required.
Ethics approval The study was performed in accordance with the declaration of Helsinki. All patients provided written informed consent. The study was approved by the Berkshire Research Ethics Committee (REC#09/H0505/132).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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