Large-vessel giant cell arteritis: a cohort study

Muratore, Francesco; Kermani, Tanaz A.; Crowson, Cynthia S.; Green, Abigail B.; Salvarani, Carlo; Matteson, Eric L.; Warrington, Kenneth J.

doi:10.1093/rheumatology/keu329

Cited by 284 publications

(276 citation statements)

References 30 publications

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“…21 In a study of 120 patients with large vessel vasculitis and 212 with more conventional cranial symptoms of GCA, but without the evidence of large vessel disease, patients with large vessel disease were significantly younger, by about 7 years, and had longer duration of symptoms prior to diagnosis (3.5 months compared with 2.2 months). There was a strong association with pre-existing polymyalgia rheumatica (PMR) in 26% of patients, compared with 15% of patients with cranial GCA, and fewer cranial symptoms (41% of patients, compared with 83% of patients with cranial GCA).…”

Section: The Spectrum Of Different Forms Of Giant Cell Arteritismentioning

confidence: 99%

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Luqmani

Lee

Singh

et al. 2016

Health Technol Assess

366

404

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Background Giant cell arteritis (GCA) is a relatively common form of primary systemic vasculitis, which, if left untreated, can lead to permanent sight loss. We compared ultrasound as an alternative diagnostic test with temporal artery biopsy, which may be negative in 9–61% of true cases. Objective To compare the clinical effectiveness and cost-effectiveness of ultrasound with biopsy in diagnosing patients with suspected GCA. Design Prospective multicentre cohort study. Setting Secondary care. Participants A total of 381 patients referred with newly suspected GCA. Main outcome measures Sensitivity, specificity and cost-effectiveness of ultrasound compared with biopsy or ultrasound combined with biopsy for diagnosing GCA and interobserver reliability in interpreting scan or biopsy findings. Results We developed and implemented an ultrasound training programme for diagnosing suspected GCA. We recruited 430 patients with suspected GCA. We analysed 381 patients who underwent both ultrasound and biopsy within 10 days of starting treatment for suspected GCA and who attended a follow-up assessment (median age 71.1 years; 72% female). The sensitivity of biopsy was 39% [95% confidence interval (CI) 33% to 46%], which was significantly lower than previously reported and inferior to ultrasound (54%, 95% CI 48% to 60%); the specificity of biopsy (100%, 95% CI 97% to 100%) was superior to ultrasound (81%, 95% CI 73% to 88%). If we scanned all suspected patients and performed biopsies only on negative cases, sensitivity increased to 65% and specificity was maintained at 81%, reducing the need for biopsies by 43%. Strategies combining clinical judgement (clinician’s assessment at 2 weeks) with the tests showed sensitivity and specificity of 91% and 81%, respectively, for biopsy and 93% and 77%, respectively, for ultrasound; cost-effectiveness (incremental net monetary benefit) was £485 per patient in favour of ultrasound with both cost savings and a small health gain. Inter-rater analysis revealed moderate agreement among sonographers (intraclass correlation coefficient 0.61, 95% CI 0.48 to 0.75), similar to pathologists (0.62, 95% CI 0.49 to 0.76). Limitations There is no independent gold standard diagnosis for GCA. The reference diagnosis used to determine accuracy was based on classification criteria for GCA that include clinical features at presentation and biopsy results. Conclusion We have demonstrated the feasibility of providing training in ultrasound for the diagnosis of GCA. Our results indicate better sensitivity but poorer specificity of ultrasound compared with biopsy and suggest some scope for reducing the role of biopsy. The moderate interobserver agreement for both ultrasound and biopsy indicates scope for improving assessment and reporting of test results and challenges the assumption that a positive biopsy always represents GCA. Future work Further research should address the issue of an independent reference diagnosis, standards for interpreting and reporting test results and the evaluation of ultrasound training, and should also explore the acceptability of these new diagnostic strategies in GCA. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: The Spectrum Of Different Forms Of Giant Cell Arteritismentioning

confidence: 99%

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Luqmani

Lee

Singh

et al. 2016

Health Technol Assess

366

404

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show abstract

“…Over the followup period, 57% received adjunctive immunosuppression in combination with prednisone: methotrexate (47%), leflunomide (4%), cyclophosphamide (4%), rituximab (1%), and hydroxychloroquine (1%). Adjunctive immunosuppression was higher compared to another large cohort 7 .…”

Section: To the Editormentioning

confidence: 67%

Cardiovascular Risk Prevention in a Canadian Population of Patients with Giant Cell Arteritis

Yeung

Barra

2017

J Rheumatol

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“…Например, для выявления гиган- Р е д а к ц и о н н а я с т а т ь я токлеточного артериита, особенно поражений экстра-краниальных артерий, рекомендуется выполнение не только ультразвуковой доплерографии артерий (чувствительность метода -67 %, специфичность -95 %) [5], но и магнитно-резонансной томографии (чувствительность -78,4 %, специфичность -90,4 %) [6], позитронно-эмиссионной томографии [7] и ком-пьютерной томографической ангиографии [8]. Результаты последних исследований позволили описать клинические особенности течения гиган-токлеточного артериита [9]. Так, пациенты с гиган-токлеточным артериитом с поражением крупных артерий младше больных классическим височным артериитом (средний возраст 68,2 ± 7,5 года в срав-нении с 75,7 ± 7,4 года, р < 0,001), имеют более длительный анамнез заболевания (3,5 мес против 2,2 мес, р < 0,001).…”

Section: диагностика системных васкулитовunclassified

Systemic Vasculitis: Novelty in Classification, Diagnosis, and Treatment

Pravdyuk¹,

Клименко²

2015

Klinicist

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Large-vessel giant cell arteritis: a cohort study

Abstract: Although patients with LV-GCA had a lower rate of vision loss, they had a higher relapse rate and greater CS requirements. The ACR criteria for GCA are inadequate for the classification of patients with LV-GCA.

Cited by 284 publications

References 30 publications

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Cardiovascular Risk Prevention in a Canadian Population of Patients with Giant Cell Arteritis

Systemic Vasculitis: Novelty in Classification, Diagnosis, and Treatment

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