Sara Monti1,2,3, Cristina Ponte4,5, Claudio Pereira3, Federica Manzoni6, Catherine Klersy6, Federica Rumi7, Greta Carrara7, Andrew Hutchings8, Wolfgang A Schmidt9, Bhaskar Dasgupta10, Roberto Caporali1, Carlomaurizio Montecucco1, Raashid Luqmani3. 1. Department of rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia. 2. PhD in Experimental Medicine, University of Pavia, Pavia, Italy. 3. NDORMS, Rheumatology Department, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK. 4. Department of Rheumatology, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon. 5. Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal. 6. Biometry and Clinical Epidemiology, IRCCS Policlinico S. Matteo Foundation, Pavia. 7. Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy. 8. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. 9. Rheumatology Department, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany. 10. Rheumatology Department, Southend University Hospital, NHS Foundation Trust, Westcliff-on-Sea, UK.
Abstract
OBJECTIVES: To develop a quantitative score based on colour duplex sonography (CDS) to predict the diagnosis and outcome of GCA. METHODS: We selected patients with positive CDS and confirmed diagnosis of GCA recruited into the TA Biopsy (TAB) vs Ultrasound in Diagnosis of GCA (TABUL) study and in a validation, independent cohort. We fitted four CDS models including combinations of the following: number and distribution of halos at the TA branches, average and maximum intima-media thickness of TA and axillary arteries. We fitted four clinical/laboratory models. The combined CDS and clinical models were used to develop a score to predict risk of positive TAB and clinical outcome at 6 months. RESULTS: We included 135 GCA patients from TABUL (female: 68%, age 73 (8) years) and 72 patients from the independent cohort (female: 46%, age 75 (7) years). The best-fitting CDS model for TAB used maximum intima-media thickness size and bilaterality of TA and axillary arteries' halos. The best-fitting clinical model included raised inflammatory markers, PMR, headache and ischaemic symptoms. By combining CDS and clinical models we derived a score to compute the probability of a positive TAB. Model discrimination was fair (area under the receiver operating characteristic curve 0.77, 95% CI: 0.68, 0.84). No significant association was found for prediction of clinical outcome at 6 months. CONCLUSION: A quantitative analysis of CDS and clinical characteristics is useful to identify patients with a positive biopsy, supporting the use of CDS as a surrogate tool to replace TAB. No predictive role was found for worse prognosis.
OBJECTIVES: To develop a quantitative score based on colour duplex sonography (CDS) to predict the diagnosis and outcome of GCA. METHODS: We selected patients with positive CDS and confirmed diagnosis of GCA recruited into the TA Biopsy (TAB) vs Ultrasound in Diagnosis of GCA (TABUL) study and in a validation, independent cohort. We fitted four CDS models including combinations of the following: number and distribution of halos at the TA branches, average and maximum intima-media thickness of TA and axillary arteries. We fitted four clinical/laboratory models. The combined CDS and clinical models were used to develop a score to predict risk of positive TAB and clinical outcome at 6 months. RESULTS: We included 135 GCA patients from TABUL (female: 68%, age 73 (8) years) and 72 patients from the independent cohort (female: 46%, age 75 (7) years). The best-fitting CDS model for TAB used maximum intima-media thickness size and bilaterality of TA and axillary arteries' halos. The best-fitting clinical model included raised inflammatory markers, PMR, headache and ischaemic symptoms. By combining CDS and clinical models we derived a score to compute the probability of a positive TAB. Model discrimination was fair (area under the receiver operating characteristic curve 0.77, 95% CI: 0.68, 0.84). No significant association was found for prediction of clinical outcome at 6 months. CONCLUSION: A quantitative analysis of CDS and clinical characteristics is useful to identify patients with a positive biopsy, supporting the use of CDS as a surrogate tool to replace TAB. No predictive role was found for worse prognosis.
Authors: Alwin Sebastian; Kornelis S M van der Geest; Fiona Coath; Prisca Gondo; Abdul Kayani; Craig Mackerness; Bernard Hadebe; Sue Innes; Jo Jackson; Bhaskar Dasgupta Journal: BMC Rheumatol Date: 2020-08-18
Authors: Charles Oshinsky; Alison M Bays; Ingeborg Sacksen; Elizabeth Jernberg; R Eugene Zierler; Andreas P Diamantopoulos; Jean W Liew; Sarah H Chung; P Scott Pollock Journal: ACR Open Rheumatol Date: 2021-10-14
Authors: Michael Czihal; Christian Lottspeich; Christoph Bernau; Teresa Henke; Ilaria Prearo; Marc Mackert; Siegfried Priglinger; Claudia Dechant; Hendrik Schulze-Koops; Ulrich Hoffmann Journal: J Clin Med Date: 2021-03-10 Impact factor: 4.241