A Diagnostic Algorithm Based on a Simple Clinical Prediction Rule for the Diagnosis of Cranial Giant Cell Arteritis

Czihal, Michael; Lottspeich, Christian; Bernau, Christoph; Henke, Teresa; Prearo, Ilaria; Mackert, Marc J.; Priglinger, Siegfried; Dechant, Claudia; Schulze‐Koops, Hendrik; Hoffmann, Ulrich

doi:10.3390/jcm10061163

Cited by 6 publications

(3 citation statements)

References 36 publications

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“…It should be noted that imaging test results should always be interpreted in the context of the level of suspicion of GCA, which is generally based on the clinical judgment and experience of the physician treating patients with GCA. Efforts have been made by different expert groups to develop pre-test clinical probability scores for GCA to help clinicians estimate the likelihood of GCA [65,66]. These scores can be potentially useful in ensuring a more homogeneous management of patients with GCA and in optimizing the performance of imaging techniques.…”

Section: Discussionmentioning

confidence: 99%

Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

Prieto-Peña

Castañeda

Martínez-Rodríguez

et al. 2021

JCM

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Early recognition of giant cell arteritis (GCA) is crucial to avoid the development of ischemic vascular complications, such as blindness. The classic approach to making the diagnosis of GCA is based on a positive temporal artery biopsy, which is among the criteria proposed by the American College of Rheumatology (ACR) in 1990 to classify a patient as having GCA. However, imaging techniques, particularly ultrasound (US) of the temporal arteries, are increasingly being considered as an alternative for the diagnosis of GCA. Recent recommendations from the European League Against Rheumatism (EULAR) for the use of imaging techniques for large vessel vasculitis (LVV) included US as the first imaging option for the diagnosis of GCA. Furthermore, although the ACR classification criteria are useful in identifying patients with the classic cranial pattern of GCA, they are often inadequate in identifying GCA patients who have the extracranial phenotype of LVV. In this sense, the advent of other imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET)/CT, has made it possible to detect the presence of extracranial involvement of the LVV in patients with GCA presenting as refractory rheumatic polymyalgia without cranial ischemic manifestations. Imaging techniques have been the key elements in redefining the diagnostic work-up of GCA. US is currently considered the main imaging modality to improve the early diagnosis of GCA.

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Section: Discussionmentioning

confidence: 99%

Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

Prieto-Peña

Castañeda

Martínez-Rodríguez

et al. 2021

JCM

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“…Multiple authors have suggested employing clinical algorithms to improve diagnostic protocol ( 19 – 21 ). Some preliminary algorithm models suggest that GCA diagnosis can be achieved through a combination of demographic information, a detailed history, physical exam, and fundoscopic findings ( 20 ). We highly recommend developing such an algorithm with stronger consideration for age and clinical manifestations before the performance of a TA biopsy.…”

Section: Discussionmentioning

confidence: 99%

Giant cell temporal arteritis: a clinicopathological study with emphasis on unnecessary biopsy

Alkatan,

AlMana,

Maktabi

2023

Front. Ophthalmol.

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IntroductionTemporal artery (TA) biopsy is commonly used for the diagnosis of giant cell arteritis (GCA). However, a positive biopsy is no longer mandatory for diagnosis. This study aims to correlate the histopathological findings of TA biopsies in suspected cases of GCA to the clinical presentation in an ophthalmic tertiary eye care center to draw useful conclusions and advocate the possible implementation of guidelines for TA biopsy.MethodsData was collected from patients’ medical records including, demographics, clinical data, and histopathological findings and diagnosis. The 2022 American College of Rheumatology/ European Alliance of Associations for Rheumatology (ACR/EULAR) criteria have been used and partially adopted as a guide to compare the variables between TA biopsy-positive and negative groups as well as the TA biopsy-positive group and the group of patients with TA biopsy showing atherosclerosis.ResultsOut of the total 35 patients who underwent a TA biopsy during the period of 23 years, 22.9% of patients had histopathological findings consistent with GCA and 42.9% had TA atherosclerotic changes, while the remaining 34.3% had histologically unremarkable TA. The mean age of all patients was 66 ± 10.9 years. Slightly more than half were females (54.3%) and the remaining were males (45.7%). In the group with positive TA biopsies, the mean age was 71 ± 8.4 years with a higher female predominance (female-to-male ratio of 5:3). The mean diagnostic clinical score used in our study was higher (7.5 ± 2.33) in the GCA-positive group when compared to the other groups with statistical significance (mean of 4.85 ± 2.01 in patients with overall GCA-negative biopsies and 5.13 ± 2.10 in the group with atherosclerosis). Other three clinical variables that were found to be statistically significant in the GCA biopsy-positive group were scalp tenderness, jaw claudication, and optic nerve pallor.DiscussionThe mean age (71 ± 8.4 years) and the female predominance of GCA in our group of patients with positive TA biopsy (62.5%) was like other reports. In our study 22.9% of performed TA biopsies over the period of the study were positive confirming the diagnosis of GCA on histological exam, which was similar to another report and is considered to be relatively low. The incorporation of increased clinically focused assessments and algorithms, with the aid of the ACR/EULAR criteria, may decrease the frequency of TA biopsies that carries unnecessary cost and risk of procedure-related morbidity. We highly recommend applying the age of ≥ 50 years as an initial criterion for diagnosis, followed by the consideration of the statistically significant clinical features: scalp tenderness, jaw claudication, and optic nerve pallor.

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“…If available, histological results of temporal artery biopsy (TAB) were collected. Based on clinical symptoms, the presence of anterior ischaemic optic neuropathy and the Creactive protein (CRP)-values, a previously published clinical prediction score for cranial GCA was calculated (15,16). As the 1990 American College of Rheumatology are not useful for diagnosis of extracranial GCA (11) and related to advances in non-invasive imaging temporal artery biopsy nowadays is dispensable in many patients (8), we applied modified disease classification criteria (16,17).…”

Section: Patient Characteristicsmentioning

confidence: 99%

Diagnostic yield of axillary artery ultrasound in addition to temporal artery ultrasound for the diagnosis of giant cell arteritis

Prearo

Dekorsy

Brendel

et al. 2022

Clinical and Experimental Rheumatology

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ObjectiveThere are limited data on the additional diagnostic yield of axillary artery ultrasound (axUS) in addition to temporal artery ultrasound (tempUS) for the diagnosis of giant cell arteritis (GCA). MethodsRetrospective study of consecutive patients with suspected GCA who underwent a standardized axUS and tempUS between 01/2015 and 03/2017. The diagnostic yield of axUS in addition to ultrasound of the temporal arteries with respect to the final clinical diagnosis was assessed, with a positive axUS defined as circumferential, hypoechogenic thickening of the far wall axillary artery intima media thickness (axIMT) ≥1.3 mm. A subgroup of patients underwent PET-CT within one week before or after the sonographic study. Separate analyses were performed regarding certain subgroups according to clinical presentation and to clinical pre-test probability for cranial GCA. GCA, 50 (54.3%), 13 (14.1%) and 15 (16.3%) had a positive tempUS, positive axUS, and combined positive tempUS and axUS, respectively. The sensitivity of sonographic imaging for the final diagnosis of GCA increased from 69.6% to 84.8%, when axUS results were considered in addition to tempUS, while the specificity remained high (no false positive axUS). Results Out of 228 patients, 92 received a final diagnosis of GCA. From the 92 patients with a final diagnosis ofThe diagnostic yield of axUS was highest in patients with a low clinical probability of cranial GCA and lowest in patients with symptoms of ocular ischemia. We observed a substantial rate (42.1%) of discordant results between axUS and PET-CT in a subgroup of 38 patients. ConclusionIn conclusion, axUS offers a substantial diagnostic yield in addition to tempUS in subjects with suspected GCA, mainly in those subjects with low clinical probability for cranial GCA.

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A Diagnostic Algorithm Based on a Simple Clinical Prediction Rule for the Diagnosis of Cranial Giant Cell Arteritis

Cited by 6 publications

References 36 publications

Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

Giant cell temporal arteritis: a clinicopathological study with emphasis on unnecessary biopsy

Diagnostic yield of axillary artery ultrasound in addition to temporal artery ultrasound for the diagnosis of giant cell arteritis

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