5 Minute Poster Presentation ARA-NSW 2020 - 42nd Annual NSW Branch Meeting

The role of clinical assessment, temporal artery ultrasound and temporal artery biopsy in the diagnosis of giant cell arteritis (#9)

Jianna He 1 , Nicholas Manolios 1 , Socrates Angelides 2 3 , David Farlow 3 , Peter Wong 1 4
  1. Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia
  2. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  3. Department of Nuclear Medicine and Ultrasound, Westmead Hospital, Sydney, NSW, Australia
  4. Rural Medical School, UNSW, Sydney, NSW, Australia

Background:

Temporal artery (TA) biopsy has traditionally been considered the gold standard in the diagnosis of giant cell arteritis (GCA). Recently, the European League Against Rheumatism has recommended temporal+/- axillary artery ultrasound (US) as the first investigation in suspected GCA in centres with readily available high quality US1. However, not all centres have expertise in TA US.

Aim:

To assess the correlation between clinical assessment, TA biopsy and US in patients admitted with suspected GCA at Westmead Hospital, Sydney.

Methods:

This was a retrospective study between January 2011 and March 2020. A review of clinical notes, inflammatory markers (ESR and CRP), TA biopsy report and US results was performed. Pearson and Spearman correlation coefficients to assess the strength of association between variables will be used.

Interim results:

Fifty-six patients (20 male and 36 female, mean age 68.8) underwent TA US during the study period. Nine (16%) had positive sonographic findings. Thirty-seven patients underwent a TA biopsy. Nine of these had positive biopsy findings Compared to the gold standard of TA biopsy, the sensitivity and specificity of TA US was 77.8% and 92.8%, respectively. Of the 19 patients who had a TA US without a TA biopsy, only one had positive US findings and was empirically treated as GCA. 

Interim conclusion:

Temporal artery US is a promising non-invasive investigation in the work-up of patients with suspected GCA. We have commenced a prospective study to assess its role in this patient group.

  1. Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018;77(5):636-43. doi: 10.1136/annrheumdis-2017-212649 [published Online First: 2018/01/24]