Diagnostic Accuracy of Symptoms, Physical Signs, and Laboratory Tests for Giant Cell Arteritis

Abstract

IMPORTANCE Current clinical guidelines recommend selecting diagnostic tests for giant cell arteritis (GCA) based on pretest probability that the disease is present, but how pretest probability should be estimated remains unclear. OBJECTIVE To evaluate the diagnostic accuracy of symptoms, physical signs, and laboratory tests for suspected GCA.

Clinical pathways for patients with giant cell arteritis during the COVID-19 pandemic: an international perspective

“…For urgent giant cell arteritis presentations, physical examination yields important diagnostic information. 56 Switching to letter and telephone follow-up communications with patients has highlighted the importance of providing patients with high-quality information about their disease and its treatment. Much of the standard written information about rheumatology drugs, such as methotrexate and tocilizumab, was originally developed for patients with inflammatory arthritis and might not seem relevant to patients with giant cell arteritis.…”

A Review on the Value of Imaging in Differentiating between Large Vessel Vasculitis and Atherosclerosis

“…An early and accurate diagnosis is vital to prevent complications in patients with LVV. However, the diagnosis is difficult as there are no disease-specific signs, symptoms, or laboratory tests that can definitively prove or reject the presence of GCA or TA [ 3 , 4 ]. The “gold standard” for diagnosing GCA, a temporal artery biopsy, has a high specificity but lower sensitivity, depending on the included patients [ 5 , 6 ].…”

Why it is time for an update on giant cell arteritis

“…While most patients describe one or more cranial symptoms, even the most common symptom of headache may only occur in two‐thirds of patients 1 . Furthermore, headache is a poor discriminator for the diagnosis with a recent meta‐analysis indicating it only marginally increases the chance of the condition with a positive likelihood ratio (LR) of 1.33 2 . While jaw claudication (LR 4.90), temporal artery abnormality on examination (3.73) and limb claudication (7.23) provide better discrimination, no one symptom, sign or blood test can confirm or refute a diagnosis.…”

“…1 Furthermore, headache is a poor discriminator for the diagnosis with a recent meta-analysis indicating it only marginally increases the chance of the condition with a positive likelihood ratio (LR) of 1.33. 2 While jaw claudication (LR 4.90), temporal artery abnormality on examination (3.73) and limb claudication (7.23) provide better discrimination, no one symptom, sign or blood test can confirm or refute a diagnosis. As well as recognizing the typical symptoms, ophthalmologists must be able to work through the differential diagnoses for cranial GCA symptoms that include cervicogenic headache, hemicrania continua, temporomandibular jaw dysfunction, herpes zoster, sinus and dental infections.…”