Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR (National Institute for Health Research) Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS (National Health Service) Trust, University of Leeds, Leeds, United Kingdom.
JAMA Intern Med. 2020 Oct 1;180(10):1295-1304. doi: 10.1001/jamainternmed.2020.3050.
Current clinical guidelines recommend selecting diagnostic tests for giant cell arteritis (GCA) based on pretest probability that the disease is present, but how pretest probability should be estimated remains unclear.
To evaluate the diagnostic accuracy of symptoms, physical signs, and laboratory tests for suspected GCA.
PubMed, EMBASE, and the Cochrane Database of Systematic Reviews were searched from November 1940 through April 5, 2020.
Trials and observational studies describing patients with suspected GCA, using an appropriate reference standard for GCA (temporal artery biopsy, imaging test, or clinical diagnosis), and with available data for at least 1 symptom, physical sign, or laboratory test.
Screening, full text review, quality assessment, and data extraction by 2 investigators. Diagnostic test meta-analysis used a bivariate model.
MAIN OUTCOME(S) AND MEASURES: Diagnostic accuracy parameters, including positive and negative likelihood ratios (LRs).
In 68 unique studies (14 037 unique patients with suspected GCA; of 7798 patients with sex reported, 5193 were women [66.6%]), findings associated with a diagnosis of GCA included limb claudication (positive LR, 6.01; 95% CI, 1.38-26.16), jaw claudication (positive LR, 4.90; 95% CI, 3.74-6.41), temporal artery thickening (positive LR, 4.70; 95% CI, 2.65-8.33), temporal artery loss of pulse (positive LR, 3.25; 95% CI, 2.49-4.23), platelet count of greater than 400 × 103/μL (positive LR, 3.75; 95% CI, 2.12-6.64), temporal tenderness (positive LR, 3.14; 95% CI, 1.14-8.65), and erythrocyte sedimentation rate greater than 100 mm/h (positive LR, 3.11; 95% CI, 1.43-6.78). Findings that were associated with absence of GCA included the absence of erythrocyte sedimentation rate of greater than 40 mm/h (negative LR, 0.18; 95% CI, 0.08-0.44), absence of C-reactive protein level of 2.5 mg/dL or more (negative LR, 0.38; 95% CI, 0.25-0.59), and absence of age over 70 years (negative LR, 0.48; 95% CI, 0.27-0.86).
This study identifies the clinical and laboratory features that are most informative for a diagnosis of GCA, although no single feature was strong enough to confirm or refute the diagnosis if taken alone. Combinations of these symptoms might help direct further investigation, such as vascular imaging, temporal artery biopsy, or seeking evaluation for alternative diagnoses.
目前的临床指南建议根据疾病存在的先验概率选择用于巨细胞动脉炎（GCA）的诊断测试，但如何估计先验概率仍不清楚。
评估疑似 GCA 的症状、体征和实验室检查的诊断准确性。
从 1940 年 11 月至 2020 年 4 月 5 日，检索了 PubMed、EMBASE 和 Cochrane 系统评价数据库。
描述疑似 GCA 患者的试验和观察性研究，使用适当的 GCA 参考标准（颞动脉活检、影像学检查或临床诊断），并具有至少 1 种症状、体征或实验室检查的可用数据。
由 2 名研究人员进行筛选、全文审查、质量评估和数据提取。使用双变量模型进行诊断测试荟萃分析。
诊断准确性参数，包括阳性和阴性似然比（LR）。
在 68 项独特的研究中（14037 名疑似 GCA 患者；在报告性别为 7798 名患者中，5193 名为女性[66.6%]），与 GCA 诊断相关的发现包括四肢跛行（阳性 LR，6.01；95%CI，1.38-26.16）、下颌跛行（阳性 LR，4.90；95%CI，3.74-6.41）、颞动脉增厚（阳性 LR，4.70；95%CI，2.65-8.33）、颞动脉搏动丧失（阳性 LR，3.25；95%CI，2.49-4.23）、血小板计数大于 400×103/μL（阳性 LR，3.75；95%CI，2.12-6.64）、颞部压痛（阳性 LR，3.14；95%CI，1.14-8.65）和红细胞沉降率大于 100mm/h（阳性 LR，3.11；95%CI，1.43-6.78）。与不存在 GCA 相关的发现包括不存在红细胞沉降率大于 40mm/h（阴性 LR，0.18；95%CI，0.08-0.44）、不存在 C 反应蛋白水平为 2.5mg/dL 或更高（阴性 LR，0.38；95%CI，0.25-0.59）和不存在年龄大于 70 岁（阴性 LR，0.48；95%CI，0.27-0.86）。
本研究确定了最有助于 GCA 诊断的临床和实验室特征，但没有任何单一特征足以单独确认或排除诊断。这些症状的组合可能有助于指导进一步的检查，如血管成像、颞动脉活检或寻求替代诊断的评估。
