Objective. Color Doppler ultrasonography (CDUS) can detect inflammation in the vessel wall.No studies have evaluated the examination of the common carotid artery by CDUS in the diagnostics of giant cell arteritis (GCA). Our aim was to evaluate the combination of CDUS examination of the temporal, axillary, and common carotid arteries in the diagnosis of GCA. Methods. Patients ages >50 years who were referred to our department between April 2010 and October 2012 and suspected to have GCA were consecutively examined. A positive clinical evaluation for GCA 6 months after the first evaluation by 3 rheumatologists was considered as the gold diagnostic standard. All patients underwent CDUS of the temporal, axillary, and common carotid arteries. A biopsy of the temporal artery was performed for most patients. Results. A total of 88 patients were assessed. Forty-six patients were diagnosed to have GCA by the defined gold standard. Forty-eight patients had a positive CDUS of the temporal artery. Forty-six patients diagnosed with GCA had a positive CDUS of the temporal, common carotid, and axillary arteries (100% sensitivity) and 4 patients had a positive CDUS without having GCA (91% specificity). Among the 39 GCA patients that underwent a biopsy, vasculitis was observed in 26 patients (66%), yielding a sensitivity of 67% and a specificity of 95%. Conclusion. CDUS of the common carotid, axillary, and temporal arteries had an excellent sensitivity and high specificity to diagnose GCA. CDUS has the potential to replace biopsy in ordinary clinical care without compromising on sensitivity and specificity.

There was no significant reduction in moderate or severe pain in a comparison of water exchange with CO2 insufflation. The secondary outcome of no pain was significantly more frequent in the water exchange group. Clinical trials registry number: NCT01633333.

Primary systemic vasculitic diseases are relatively rare. Untreated, they have a high morbidity and mortality. The introduction of steroids and cytotoxic drugs has dramatically reduced the mortality. In a retrospective study in a Norwegian community hospital, which serves a county with a population of 150,426 in 1996, 68 patients were found to have a primary vasculitis, 63 of whom fulfilled the ACR 1990 criteria. Patients with Henoch-Schönlein purpura aged less than 16 years and patients with Kawasaki's disease were excluded. The overall prevalence was 43.9 per 100,000 inhabitants (Churg-Strauss syndrome 1.3, hypersensitivity vasculitis 2.7, Henoch-Schönlein purpura 3.3, polyarteritis nodosa 3.3, Wegener's granulomatosis 5.3 and temporal arteritis 27.9). In most cases, disease control was achieved with corticosteroids alone, or with the addition of cytotoxic drugs. Two patients had died in the latest 5-year period but of unrelated disorders. Biopsy plays a major role in diagnosing vasculitic diseases. In our study, 62 patients had a positive biopsy supporting the diagnosis.

Background: Early detection of cobalamin deficiency is clinically important, and there is evidence that such deficiency occurs more frequently than previously anticipated. However, serum cobalamin and other commonly used tests have limited ability to diagnose a deficiency state. Methods: We investigated the ability of hematological variables, serum cobalamin, plasma total homocysteine (tHcy), serum and erythrocyte folate, gastroscopy, age, and gender to predict cobalamin deficiency. Patients (n = 196; age range, 17–87 years) who had been referred from general practice for determination of serum cobalamin were studied. Cobalamin deficiency was defined as serum methylmalonic acid (MMA) >0.26 μmol/L with at least 50% reduction after cobalamin supplementation. ROC and logistic regression analyses were used. Results: Serum cobalamin and tHcy were the best predictors, with areas under the ROC curve (SE) of 0.810 (0.034) and 0.768 (0.037), respectively, but age, intrinsic factor antibodies, and gastroscopy gave additional information. Conclusions: When cobalamin deficiency is suspected in general practice, serum cobalamin should be the first diagnostic test, and the result should be interpreted in relation to the age of the patient. When a definite diagnosis cannot be reached, MMA and tHcy determination will provide additional discriminative information, but MMA, being more specific, is preferable for assessment of cobalamin status.

In a retrospective study of primary vasculitis in a Norwegian community hospital 6 patients were found to have polyarteritis nodosa (PAN). Five of them had taken a temporal artery biopsy and in all biopsies vasculitic changes were found, but no giant cells. Muscle biopsies from each of the patients showed the same major vasculitic changes as in the temporal artery. The histopathological findings could not exclude temporal arteritis (TA). None of the 5 polyarteritis patients who all fulfilled the ACR 1990 criteria had a case history typical for TA. Our results give the impression that vasculitic changes in the temporal artery may be a frequent finding in PAN. An atypical case history of TA with vasculitis in the temporal artery without giant cells and atypical histopathological findings should lead to the suspicion of PAN or another primary vasculitis. We also recommend a temporal artery biopsy in all cases of suspected PAN.