Cristina Ponte1,2, Ana Sofia Serafim3, Sara Monti4,5, Elisabete Fernandes6, Ellen Lee7, Surjeet Singh8, Jennifer Piper8, Andrew Hutchings9, Eugene McNally10, Andreas P Diamantopoulos11, Bhaskar Dasgupta12, Wolfgang A Schmidt13, Raashid Ahmed Luqmani8. 1. Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte. 2. Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon. 3. Internal Medicine Department, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal. 4. Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavai. 5. PhD in Experimental Medicine, University of Pavia, Pavia, Italy. 6. Biomathematics Laboratory, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal. 7. Clinical Trials Research Unit, ScHARR, The University of Sheffield, Sheffield. 8. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford. 9. London School of Hygiene and Tropical Medicine, London. 10. Oxford Musculoskeletal Radiology, Oxford, UK. 11. Department of Rheumatology, Martina Hansens Hospital, Bærum Oslo, Norway. 12. Department of Rheumatology, Southend Hospital NHS Trust, Westcliff-on-Sea, UK. 13. Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany.
Abstract
OBJECTIVES: To compare the ultrasound characteristics with clinical features, final diagnosis and outcome; and to evaluate the halo size following glucocorticoid treatment in patients with newly diagnosed GCA. METHODS: Patients with suspected GCA, recruited from an international cohort, had an ultrasound of temporal (TA) and axillary (AX) arteries performed within 7 days of commencing glucocorticoids. We compared differences in clinical features at disease presentation, after 2 weeks and after 6 months, according to the presence or absence of halo sign. We undertook a cross-sectional analysis of the differences in halo thickness using Pearson's correlation coefficient (r) and Analysis of Variance (ANOVA). RESULTS: A total of 345 patients with 6 months follow-up data were included; 226 (65.5%) had a diagnosis of GCA. Jaw claudication and visual symptoms were more frequent in patients with halo sign (P =0.018 and P =0.003, respectively). Physical examination abnormalities were significantly associated with the presence of ipsilateral halo (P <0.05). Stenosis or occlusion on ultrasound failed to contribute to the diagnosis of GCA. During 7 days of glucocorticoid treatment, there was a consistent reduction in halo size in the TA (maximum halo size per patient: r=-0.30, P =0.001; and all halos r=-0.23, P <0.001), but not in the AX (P >0.05). However, the presence of halo at baseline failed to predict future ischaemic events occurring during follow-up. CONCLUSION: In newly diagnosed GCA, TA halo is associated with the presence of ischaemic features and its size decreases following glucocorticoid treatment, supporting its early use as a marker of disease activity, in addition to its diagnostic role.
OBJECTIVES: To compare the ultrasound characteristics with clinical features, final diagnosis and outcome; and to evaluate the halo size following glucocorticoid treatment in patients with newly diagnosed GCA. METHODS:Patients with suspected GCA, recruited from an international cohort, had an ultrasound of temporal (TA) and axillary (AX) arteries performed within 7 days of commencing glucocorticoids. We compared differences in clinical features at disease presentation, after 2 weeks and after 6 months, according to the presence or absence of halo sign. We undertook a cross-sectional analysis of the differences in halo thickness using Pearson's correlation coefficient (r) and Analysis of Variance (ANOVA). RESULTS: A total of 345 patients with 6 months follow-up data were included; 226 (65.5%) had a diagnosis of GCA. Jaw claudication and visual symptoms were more frequent in patients with halo sign (P =0.018 and P =0.003, respectively). Physical examination abnormalities were significantly associated with the presence of ipsilateral halo (P <0.05). Stenosis or occlusion on ultrasound failed to contribute to the diagnosis of GCA. During 7 days of glucocorticoid treatment, there was a consistent reduction in halo size in the TA (maximum halo size per patient: r=-0.30, P =0.001; and all halos r=-0.23, P <0.001), but not in the AX (P >0.05). However, the presence of halo at baseline failed to predict future ischaemic events occurring during follow-up. CONCLUSION: In newly diagnosed GCA, TA halo is associated with the presence of ischaemic features and its size decreases following glucocorticoid treatment, supporting its early use as a marker of disease activity, in addition to its diagnostic role.
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: Jianna He; Luke Williamson; Beverly Ng; Jeremy Wang; Nicholas Manolios; Socrates Angelides; David Farlow; Peter K K Wong Journal: Int J Rheum Dis Date: 2022-01-22 Impact factor: 2.558