Vascular Ultrasound Deserves Wider Use in Diagnosing GCA in the US
Researchers suggest that a multidisciplinary model for incorporating vascular ultrasound (VUS) into giant cell arteritis (GCA) care—similar to existing European models—should be more widely applied in the United States, where use of VUS has been limited.
The investigators analyzed results from the evaluation of 530 patients with suspected GCA conducted at a major US medical center between 2013 and 2017. Vascular technologists visualized the bilateral temporal, subclavian, carotid, and axillary arteries according to a specified protocol. Vascular medicine physicians then interpreted the results of VUS as “no arteritis,” “hyperechoic wall thickening,” or “acute arteritis.”
Most patients (84.3%) had no arteritis on VUS, the researchers noted, while 10.6% had acute arteritis and 5.1% had hyperechoic wall thickening. In addition, 31.7% of the patients studied evidenced polymyalgia rheumatica, 10.6% showed prior onset of GCA, and 57.6% were taking corticosteroids.
The characteristics of patients with acute arteritis were compared to those without arteritis or hyperechoic wall thickening. The researchers also compared the treating physicians’ pretest and posttest suspicions of new‐onset GCA among these patients.
“Typical GCA symptoms, such as jaw claudication and scalp tenderness, were significantly more frequent in patients with acute arteritis. For all 42 patients with suspected new‐onset GCA and acute arteritis, posttest suspicion was unchanged or increased. Of 415 patients with suspected new‐onset GCA and VUS without acute arteritis, suspicion decreased (76.4%) or was unchanged (20.2%),” the authors concluded.
Tedeschi S, Sobiesczyzk P, Ford J, DiIorio M, Docken W. Clinical experience with a multidisciplinary model of vascular ultrasound for the evaluation for giant cell arteritis. Arthritis Rheum. Published online February 11, 2021.