The proposed role of ultrasound in the management of giant cell arteritis in routine clinical practice

Monti, Sara; Floris, Alberto; Ponte, Cristina; Schmidt, Wolfgang A.; Diamantopoulos, Andreas P.; Pereira, Cláudio Maranhão; Vaggers, Sophie; Luqmani, Raashid

doi:10.1093/rheumatology/kex341

Cited by 57 publications

(47 citation statements)

References 15 publications

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“…The aorta may be a particularly vulnerable region for this process and long‐term follow‐up will be required to assess if persistent activity predicts the development of aortic aneurysm. Similar challenges have been described for other imaging modalities such as ultrasound and magnetic resonance imaging when assessing patients in clinical remission …”

Section: Discussionmentioning

confidence: 78%

Cranial and large vessel activity on positron emission tomography scan at diagnosis and 6 months in giant cell arteritis

et al. 2020

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Aim: Positron emission tomography/computed tomography (PET/CT) can detect cranial and large vessel inflammation in giant cell arteritis (GCA). We aimed to determine the change and significance of vascular activity at diagnosis and 6 months.Method: Newly diagnosed GCA patients underwent time-of-flight fluorine-18-fluoro-2-deoxyglucose PET/CT from vertex to diaphragm within 72 hours of commencing corticosteroids and were followed for 12 months. A 6 months scan was performed in patients with inflammatory features on biopsy or CT aortitis. Vascular uptake was visually graded by 2 blinded readers across 18 artery segments from 0 (no increased uptake) to 3 (very marked uptake). Scores were summed to give a total vascular score (TVS). Results:We enrolled 21 GCA patients and 15 underwent the serial scan. Twelve (57%) patients experienced a relapse and 5 of these had ischemic features of vision disturbance, jaw or limb claudication. The median TVS fell from 14 (interquartile range [IQR] 4-24) at baseline to 5 (IQR 0-10) at 6 months (P < .01) with reduction in both cranial and large artery scores. While the overall relapse rate was similar between patients with a high (≥10) and low baseline TVS, patients with high scores were numerically more likely to experience an ischemic relapse (33% vs 11%, P = .34). Five out of 15 patients had persistent uptake in at least 1 vessel on the serial PET/CT but none experienced a subsequent relapse. Conclusion:Vascular activity decreased in cranial and large arteries between diagnosis and 6 months. Persistent activity did not predict subsequent relapse. K E Y W O R D S giant cell arteritis, positron emission tomography, prognosis, systemic vasculitis | 583 SAMMEL Et AL.

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Section: Discussionmentioning

confidence: 78%

Cranial and large vessel activity on positron emission tomography scan at diagnosis and 6 months in giant cell arteritis

et al. 2020

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“…Major advantages of CDUS are that it is non-invasive and can sample the majority of main arterial territories which can be affected such as the common superficial temporal artery, frontal and parietal branches as well as axillary, carotid, subclavian and vertebral arteries [45,46]. The Temporal Artery Biopsy vs Ultrasound in Diagnosis of Giant Cell Arteritis (TABUL) study, a crosssectional prospective study of 381 patients investigated for GCA, has given the most comprehensive analysis of use of CDUS in GCA [45]; with this evidence CDUS has allowed for a significant reduction in the requirement for temporal artery biopsy [47]. 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG-PET) has traditionally been technically difficult to interpret in cranial disease due to the brain activity and the size of the temporal vessels being assessed.…”

Section: Recommendationmentioning

confidence: 99%

European Headache Federation recommendations for neurologists managing giant cell arteritis

et al. 2020

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Background and aim: Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA. Methods: The working group identified relevant questions, performed systematic literature review and assessed the quality of available evidence, and wrote recommendations. Where there was not a high level of evidence, the multidisciplinary (neurology, ophthalmology and rheumatology) group recommended best practice based on their clinical experience. Results: Across Europe, fast track pathways and the utility of advanced imaging techniques are helping to reduce diagnostic delay and uncertainty, with improved clinical outcomes for patients. GCA is treated with high dose glucocorticoids (GC) as a first line agent however long-term GC toxicity is one of the key concerns for clinicians and patients. The first phase 2 and phase 3 randomised controlled trials of Tocilizumab, an IL-6 receptor antagonist, have been published. It is now been approved as the first ever licensed drug to be used in GCA. Conclusion: The present article will outline recent advances made in the diagnosis and management of GCA.

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“…In a recent study of 293 patients among new referrals with < 7 days of GC treatment, the sensitivity of CDUS was 63.3% (95% CI: 44–80%), specificity 100% (95% CI: 83–100%), positive predictive value 100% and negative predictive value 64.5% (95% CI: 53–74%) …”

Section: Imagingmentioning

confidence: 99%

Diagnosis and management of giant cell arteritis: an Asia‐Pacific perspective

2018

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Giant cell arteritis is the commonest primary vasculitis of the elderly. However, the prevalence does vary widely between populations with highest incidence amongst Northern Europeans and lowest amongst East Asians. Preliminary studies suggest that clinical manifestations may differ between different populations. Newer diagnostic approaches including ultrasound, MR angiography and PET imaging are under review. While there have been recent advances in the diagnosis of GCA particularly with regard to imaging, there is an urgent need for improvements in methods of diagnosis, treatment and requirement for screening. Glucocorticoid treatment remain the backbone of therapy. However, glucocorticoid therapy is associated with significant adverse effects. Conventional and novel immunosuppressive agents have only demonstrated modest effects in a subgroup of steroid refractory GCA due to the different arms of the immune system at play. However, recently a study of IL-6 blockade demonstrated benefit in GCA. Newer approaches such as fast-track pathways can also result in improvements in consequences of GCA including blindness.

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The proposed role of ultrasound in the management of giant cell arteritis in routine clinical practice

Abstract: CDS provides high positive predictive value for diagnosing GCA and allows for a significant reduction in temporal artery biopsies. We explored the role of CDS in detecting flares and demonstrated a relationship to the extent of the distribution of halos, but not to their size.

Cited by 57 publications

References 15 publications

Cranial and large vessel activity on positron emission tomography scan at diagnosis and 6 months in giant cell arteritis

Cranial and large vessel activity on positron emission tomography scan at diagnosis and 6 months in giant cell arteritis

European Headache Federation recommendations for neurologists managing giant cell arteritis

Diagnosis and management of giant cell arteritis: an Asia‐Pacific perspective

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