Background/Purpose: Recent data show that the extensiveness of inflammation observed on colour Doppler ultrasonography (CDS) may indicate the risk for ocular ischaemia giant cell arteritis (GCA) patients. ¹

The aim of our prospective study was to evaluate potential correlation between the clinical presentation of GCA and the extensiveness of vascular involvement assessed by CDS in preselected cranial and aortic arch arteries.

Methods: We performed CDS in incipient GCA patients between October 2013 and May 2020, using a Philips IU22 with 5–17.5 MHz linear probe or Philips Epiq 7 with 5–18.5 MHz linear probe. A total of 14 arteries were examined: bilateral temporal (main, frontal and parietal branch were considered as one vessel territory), facial, occipital, thyroid, carotid, vertebral, subclavian, and axillary arteries. A halo with positive compression sign was considered a positive finding. We explored correlations were explored between GCA clinical features and the number of involved vessels using Spearman test.

Results: During the 80-month observation period we diagnosed GCA in 267 patients (66.3% females, median (IQR) age 74.9 (67.0–80.4) years), median (IQR) symptom duration time 30 (21; 60) days). The CDS was positive in 263/267 (98.5%) patients in at least one of the examined arteries (range from 1 to 12). Table 1 shows the number of patients by number of involved vessels. 

We observed a very weak positive correlation between symptom duration and the number of affected vessels (0.14 (95%CI 0.02; 0.25), p=0.024), and very weak inverse correlation between headache and the number of affected vessels (-0.14 (95%CI -0.24;-0.02), p=0.023). There was no significant correlation between patient age, sex, the presence of constitutional symptoms, polymyalgia rheumatica, vision manifestations (including severe manifestations), jaw claudication, ESR, CRP, haemoglobin level, platelet count, and the extensiveness of vascular involvement in GCA.

Conclusion: In our incipient GCA cohort, we found no strong correlation between the extent of vascular involvement, assessed by CDS of cranial and aortic arch arteries, and clinical symptoms, but there was a trend for patients with longer symptom duration to have more extensive vessel involvement.

Reference: 1. van der Geest KSM, et al. ARD 2020;79:393–9. doi:10.1136/annrheumdis-2019-216343.

Table 1. Patients by the number of vessels involved on CDS examination

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/giant-cell-arteritis-the-relationship-between-the-extensiveness-of-vasculitis-and-the-clinical-presentation/