Background and Aims

Giant cell arteritis (GCA) is a medical emergency. Ultrasound (US) halo sign is useful in diagnosing GCA. We propose a novel ultrasound Halo Score (HS) as a potential marker to diagnose and assess disease activity in GCA patients.

Methods

Prospective multicentre study (HAS GCA) including 80 suspected GCA patients from fast track referrals at baseline and 3 months follow-up. Southend pre-test probability score stratified patients to Low, Intermediate, High-risk. HS calculated from intimal medial thickness in bilateral temporal artery branches (TAHS) and axillary arteries (AAHS), summed a Total Halo Score (THS). GCA diagnosis; clinical, positive US/additional test with CRP >5 mg/dl

Results

Twenty-seven (34%) confirmed GCA, 53 (66%) non-GCA (controls), median age 72.0 in GCA, 52% females in GCA and 70% controls. GCA and controls stratification Low (0% vs 100%), Intermediate (24% vs 76%), High risk (71% vs 29%). Jaw-claudication, polymyalgia in GCA (63% and 56%) versus controls (3% and 8%), prior vision loss 22% GCA versus 4 % controls. 38% controls on glucocorticoids (GC) at presentation. 3-month median cumulative GC dose in GCA 2875 grams

US had a high sensitivity (96%), specificity (98%) and accuracy (98%) in diagnosing GCA. 63% (17) GCA have completed 3 months follow up. Baseline median THS in GCA and control was 21 and 4 respectively (p=0.0001). 3-month median TAHS, AAHS and THS reduced from 10 to 3, 12 to 6 and 21 to 10.

Conclusions

Southend HS successfully discriminates GCA from non GCA mimics, quantifies vascular inflammation and helps assessing response in GCA.

Background and Aims

Giant cell arteritis (GCA) is a medical emergency. Ultrasound (US) halo sign is useful in diagnosing GCA. We propose a novel ultrasound Halo Score (HS) as a potential marker to diagnose and assess disease activity in GCA patients.

Methods

Prospective multicentre study (HAS GCA) including 80 suspected GCA patients from fast track referrals at baseline and 3 months follow-up. Southend pre-test probability score stratified patients to Low, Intermediate, High-risk. HS calculated from intimal medial thickness in bilateral temporal artery branches (TAHS) and axillary arteries (AAHS), summed a Total Halo Score (THS). GCA diagnosis; clinical, positive US/additional test with CRP >5 mg/dl

Results

Twenty-seven (34%) confirmed GCA, 53 (66%) non-GCA (controls), median age 72.0 in GCA, 52% females in GCA and 70% controls. GCA and controls stratification Low (0% vs 100%), Intermediate (24% vs 76%), High risk (71% vs 29%). Jaw-claudication, polymyalgia in GCA (63% and 56%) versus controls (3% and 8%), prior vision loss 22% GCA versus 4 % controls. 38% controls on glucocorticoids (GC) at presentation. 3-month median cumulative GC dose in GCA 2875 grams

US had a high sensitivity (96%), specificity (98%) and accuracy (98%) in diagnosing GCA. 63% (17) GCA have completed 3 months follow up. Baseline median THS in GCA and control was 21 and 4 respectively (p=0.0001). 3-month median TAHS, AAHS and THS reduced from 10 to 3, 12 to 6 and 21 to 10.

Conclusions

Southend HS successfully discriminates GCA from non GCA mimics, quantifies vascular inflammation and helps assessing response in GCA.