Background/Purpose
The TABUL study (Temporal Artery Biopsy Vs Ultrasound in diagnosis of Giant Cell Arteritis) is assessing the relative performance of ultrasound and temporal artery biopsy for diagnosing GCA. All patients with newly suspected GCA underwent a single ultrasound scan of both temporal and axillary arteries within 7 days of commencing glucocorticoid therapy. We aimed to examine the ultrasound response to treatment as a potential biomarker in GCA, by measuring differences in the size of the halo around the arteries with different steroid duration within a 7 day period; furthermore we correlated the halo size with ischaemic symptoms of GCA.
Methods
All 415 cases with suspected GCA had an ultrasound examination of the temporal and axillary arteries and a biopsy of the temporal artery within 7 days of inclusion. The 301 patients with clinically defined definite or probable GCA at baseline were included in this analysis. Using the IBM SPSS Statistics package v20, we performed a cross-sectional analysis with linear and logistic regression models to determine the relationship of the halo size with days of steroid treatment and with ischaemic symptoms of GCA (jaw and tongue claudication, amaurosis fugax and reduced, lost or double vision).
Results
We included 214 women and 87 men (mean age 72.6 and 71.2 years old respectively) from 20 different recruitment centres. Fifty percent were scanned on the second day of steroid treatment or before. Forty three per cent (131 patients) had one or more temporal segments with a halo, 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 the temporal arteries. The likelihood of finding a halo diminished with time, which was confirmed in a logistic regression until day 4 of steroid treatment (p<0.005), whereas this trend was not possible to predict after that time. At least one ischaemic symptom was present in 42% of the patients: jaw claudication in 48.2% (146 patients), reduced or lost vision in 36.6% (111 patients), double vision in 8.6% (26 patients), tongue claudication in 6.6% (20 patients) and amaurosis fugax in 4% (12 patients). The presence of jaw claudication was more frequent in patients with a halo (p<0.05). The symptomatic side of temporal arteries correlated significantly with the ipsilateral ultrasound findings (p<0.05 for right and left side findings on physical examination).
Conclusion
In newly diagnosed GCA, ultrasound halo size decreases with steroid treatment and correlates with the presence of ischaemic symptoms, supporting its early use as a diagnostic and potentially prognostic marker. We are exploring the potential value of change in halo size in individual patients over time to determine its value in monitoring response to treatment.
Disclosure:
A. S. Serafim,
None;
S. Singh,
None;
J. Piper,
None;
A. Hutchings,
None;
M. Bradburn,
None;
C. Ponte,
None;
B. Dasgupta,
Novartis Pharma AG,
2;
W. A. Schmidt,
Novartis Pharma AG,
2,
Mundipharma,
2;
A. P. Diamantopoulos,
None;
E. McNally,
None;
R. Luqmani,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-halo-sign-features-on-ultrasound-examination-of-treated-patients-with-giant-cell-arteritis/