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We thank Evangelatos et al1 for their interest in our study on the ultrasonographic Halo Score for giant cell arteritis (GCA).2 The evaluation of patients with suspected GCA can be challenging.3 Ultrasonography is an important diagnostic tool for GCA and allows to evaluate key arteries affected by the disease.4 Currently, it is recommended to perform ultrasonography of the temporal and axillary arteries in patients with suspected GCA.5 6 For this reason, the ultrasonographic Halo Score is based on measurements of these two arteries. Whether or not additional arteries should be evaluated remains a topic of debate.7 8
We welcome the effort of Evangelatos et al to evaluate the ‘diagnostic yield’ of ultrasonography of the facial arteries,1 9 in addition to standard examination of the temporal and axillary arteries. The authors observed a halo of the facial artery in 4 out of the 11 patients with a halo of the temporal artery. In the absence of a temporal artery halo, no facial artery halo was observed. Examination of the facial artery thus provided little diagnostic yield, as previously reported by Ješe et al.10 The study by Evangelatos et al underscores that ultrasonography of temporal and axillary arteries might be sufficient for the initial evaluation of patients with suspected GCA. Bearing in mind the need for additional time and technical skills, other arteries (eg, facial artery, subclavian artery) could be evaluated in selected cases.
In essence, the ultrasonographic Halo Score is a tool to estimate the burden of inflammation in patients with GCA. We have previously reported on the diagnostic accuracy of the Halo Score and its relationship with systemic inflammation and clinical features of GCA.2 Molina Collada et al confirmed the diagnostic value of the Halo Score in standard clinical practise.11 12 More recently, we observed that the ultrasonographic Halo Score associates with intimal hyperplasia, a key biopsy feature linked to GCA-related ocular ischaemia (Van der Geest et al., in press). The value of the Halo Score for monitoring of disease activity is currently under investigation in a prospective, multicentre study.13 Although inclusion of additional arteries in the Halo Score could potentially make the estimation of the inflammatory burden more precise, it is questionable whether this would significantly improve the diagnostic accuracy of the Halo Score and its relationship with systemic inflammation, as outlined by Evangelatos et al. It may make the Halo Score more burdensome and imprecise to assess—reflecting the increased time commitment and variability of skills not only in demonstrating a facial artery halo but also in measuring its halo thickness.
Handling editor Josef S Smolen
Contributors Both authors wrote the manuscript, revised it critically for important intellectual content and provided final approval of the version published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests KSMvdG reports grants from the Mandema Stipend and the Dutch Society for Rheumatology, and personal fees from 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 Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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