Session Information
Date: Monday, November 9, 2015
Title: Vasculitis Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Giant cell arteritis (GCA) is the most common systemic vasculitis in patients over 50 years of age. Large vessel disease outside temporal arteries is increasingly being recognised. Our aim was to evaluate the involvement of large epiaortic arteries in patients with GCA using Colour Doppler Ultrasonography (CDS) in daily clinical practice.
Methods:
CDS of epiaortic arteries was performed using a 5–17.5 MHz linear probe in patients with newly diagnosed GCA prior to or up to 2 days after starting glucocorticoids. Carotid, vertebral, subclavian, axillary as well as occipital, facial and thyroid arteries were assessed in longitudinal and transversal planes. The “halo sign” (i.e. a hypoechoic circumferential wall thickening, was considered a positive finding.
Results:
From September 1, 2011 to May 31, 2015 CDS of epiaortic arteries was performed in 87 GCA patients. In 33/87 patients (37.9%) involvement of examined arteries was found. (Table 1).A single artery region was affected in 13 patients (39.4%), and 20 patients had more than one vascular region affected.
The group of patients with large artery involvement had significantly longer disease duration (p= 0.009), were more commonly females (p=0.003), had less commonly positive CDS of temporal arteries (p=0,023) and had a higher risk for severe visual disturbances (50% vs. 9.1% permanent visual loss, relative risk 5.5 (95%CI 1.2-25.8)), than those without large vessel involvement. Clinical characteristics of both groups are presented in Table 2.
Table 1. Large artery disease in GCA patients, assessed by DCS
|
Arteries |
GCA cases with vasculitic changes (%) |
|
Carotid arteries |
12.6% |
|
Vertebral arteries |
11.5% |
|
Subclavian arteries |
17.2% |
|
Axillary arteries |
17.2% |
|
Thyroid artereis |
3.4% |
|
Occipital arteries |
17.8% |
|
Facial arteries |
17.8% |
Table 2. Clinical characteristics of GCA patients with or without large artery disease
|
Characteristics |
GCA with large vessel disease (33) |
GCA without large vessel disease (54) |
|
gender (F:M ratio) |
10 |
1.6 |
|
age (yrs; median, IQR) |
72.1 (66.3; 78.6) |
74.9 (68.7; 78.8) |
|
disease duration (days, median, IQR) |
60 (30; 101) |
29 (14; 60) |
|
general symptoms (%) |
84.2% |
70.4% |
|
PMR symptoms (%) |
15.2% |
20.4% |
|
new headache (%) |
66.7% |
77.8% |
|
jaw claudication (%) |
39.4% |
42.6% |
|
visual disturbances (%) |
18.2% |
40.7% |
|
permanent visual loss (% of visual dist.) |
50% |
9.1% |
|
dry cough (%) |
24.2% |
16.7% |
|
|
|
|
|
ESR (mm/h; median , IQR) |
89 (59; 109) |
81 (58; 101) |
|
CRP (mg/l; median, IQR) |
82 (51; 122) |
63 (32; 124) |
|
positive TA biopsy (%) |
78.3% |
85.4% |
|
positive TA CDS (%) |
66.7% |
88.9% |
Conclusion:
Epiaortic large artery involvement was demonstrated in more than 1/3 of our GCA cases. CDS of epiaortic arteries in addition to CDS of temporal arteries increases the diagnostic yield in GCA.
To cite this abstract in AMA style:
Hocevar A, Ješe R, Rotar Z, Tomšič M. Colour-Doppler Ultrasonography of Epiaortic Arteries in Patients with Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/colour-doppler-ultrasonography-of-epiaortic-arteries-in-patients-with-giant-cell-arteritis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/colour-doppler-ultrasonography-of-epiaortic-arteries-in-patients-with-giant-cell-arteritis/