Objectives To compare the ultrasound characteristics with clinical features, final diagnosis and outcome; and to evaluate the halo size following glucocorticoid treatment in patients with newly diagnosed GCA. Methods Patients with suspected GCA, recruited from an international cohort, had an ultrasound of temporal (TA) and axillary (AX) arteries performed within 7 days of commencing glucocorticoids. We compared differences in clinical features at disease presentation, after 2 weeks and after 6 months, according to the presence or absence of halo sign. We undertook a cross-sectional analysis of the differences in halo thickness using Pearson’s correlation coefficient (r) and Analysis of Variance (ANOVA). Results A total of 345 patients with 6 months follow-up data were included; 226 (65.5%) had a diagnosis of GCA. Jaw claudication and visual symptoms were more frequent in patients with halo sign (P�=0.018 and P�=0.003, respectively). Physical examination abnormalities were significantly associated with the presence of ipsilateral halo (P�<0.05). Stenosis or occlusion on ultrasound failed to contribute to the diagnosis of GCA. During 7 days of glucocorticoid treatment, there was a consistent reduction in halo size in the TA (maximum halo size per patient: r=−0.30, P�=0.001; and all halos r=−0.23, P�<0.001), but not in the AX (P�>0.05). However, the presence of halo at baseline failed to predict future ischaemic events occurring during follow-up. Conclusion In newly diagnosed GCA, TA halo is associated with the presence of ischaemic features and its size decreases following glucocorticoid treatment, supporting its early use as a marker of disease activity, in addition to its diagnostic role.

Background: The Temporal Artery Biopsy vs US in diagnosis of GCA (TABUL) study compared temporal artery US with biopsy for diagnosing GCA. All patients with newly suspected GCA underwent a single US scan of temporal and axillary arteries, followed by a biopsy of the symptomatic temporal artery within 7 days of starting steroids. To determine the potential role of US as a biomarker in GCA, we measured differences in the size of the halo around the arteries with different duration of steroid therapy; furthermore we correlated halo size with ischaemic symptoms of GCA. Methods: We included 415 cases with suspected GCA. We analysed data from 301/415 patients with clinically defined definite or probable GCA at baseline. Using the IBM SPSS Statistics package version 20, we performed a cross-sectional analysis with linear and logistic regression models to determine the relationship between halo size and days of steroid treatment and also with ischaemic symptoms of GCA (jaw and tongue claudication, amaurosis fugax and reduced, lost or double vision). Results: We studied 214 women and 87 men [mean (S.D.) age 72.6 (9.3) and 71.6 (9.6) years, respectively] from 20 different recruitment centres. Fifty per cent were scanned on or before day 2 of steroid treatment. Forty-three per cent (131 patients) had a halo in one or more temporal segments, 48.5% (146 patients) had bilateral temporal artery halos and 12.6% (38 patients) had axillary involvement. The linear regression model showed a consistently smaller halo size over the 7 days of steroid treatment (P < 0.005) for temporal arteries.

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