Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
Clin Rheumatol. 2021 Jul;40(7):2821-2827. doi: 10.1007/s10067-020-05577-4. Epub 2021 Jan 11.
To assess whether adding the subclavian artery examination into the ultrasound (US) Southend Halo Score, as proposed in the modified Halo Score, improves the diagnostic accuracy of giant cell arteritis (GCA) and its relationship with systemic inflammation.
Retrospective observational study of patients referred to a GCA fast track pathway (FTP) over a 1-year period. Patients underwent US exam of temporal and large vessel (LV) (carotid, subclavian, and axillary) arteries. The extent of inflammation was measured by the halo count, the Southend Halo Score, and the modified Halo Score. The gold standard for GCA diagnosis was clinical confirmation after 6-month follow-up.
Sixty-four patients were evaluated in the FTP, 17 (26.5%) had GCA. Subclavian artery involvement was present only in patients with GCA (29.4% versus 0%, p < 0.001). Overall, the three scores showed excellent diagnostic accuracy for GCA (ROC AUC 0.906, 0.930, and 0.928, respectively) and moderate correlations with acute phase reactants (0.35-0.51, p < 0.01). Only the modified Halo Score correlated with markers of inflammation in patients with LV involvement.
The inclusion of subclavian artery examination in the modified Halo Score does not improve the diagnostic accuracy of GCA. Nevertheless, it correlates better with markers of systemic inflammation in LV-GCA. Key Points • Adding the subclavian artery examination into the Southend Halo Score, as proposed in the modified Halo Score, does not improve the diagnostic accuracy of GCA. • However, the extent of vascular inflammation as quantified by the modified Halo Score correlates better with markers of systemic inflammation in the large vessel (LV) GCA subgroup of patients. • Although the diagnostic value of adding subclavian arteries to the current recommended US examination of GCA is limited, it may have a role in monitoring disease activity as it correlates with the general burden of inflammation in LV GCA. These findings need to be confirmed in additional populations and larger prospective studies.
评估在改良 Halo 评分中提出的将锁骨下动脉检查纳入超声（US） Southend Halo 评分是否能提高巨细胞动脉炎（GCA）的诊断准确性及其与全身炎症的关系。
对在 1 年内被纳入 GCA 快速通道（FTP）的患者进行回顾性观察性研究。患者接受颞动脉和大血管（LV，包括颈动脉、锁骨下动脉和腋动脉）的 US 检查。通过 Halo 计数、Southend Halo 评分和改良 Halo 评分来测量炎症程度。GCA 的诊断金标准是在 6 个月的随访后临床确诊。
FTP 共评估了 64 例患者，其中 17 例（26.5%）患有 GCA。锁骨下动脉受累仅见于 GCA 患者（29.4%比 0%，p < 0.001）。总的来说，这三个评分对 GCA 都具有很高的诊断准确性（ROC AUC 分别为 0.906、0.930 和 0.928），与急性期反应物的相关性中等（0.35-0.51，p < 0.01）。只有在 LV 受累的患者中，改良 Halo 评分与炎症标志物相关。
将锁骨下动脉检查纳入改良 Halo 评分并不能提高 GCA 的诊断准确性。然而，它与 LV-GCA 患者的系统性炎症标志物相关性更好。关键点：
将锁骨下动脉检查纳入 Southend Halo 评分中提出的改良 Halo 评分并不会提高 GCA 的诊断准确性。
然而，改良 Halo 评分量化的血管炎症程度与 LV-GCA 患者的系统性炎症标志物相关性更好。
尽管将锁骨下动脉纳入目前推荐的 GCA US 检查的诊断价值有限，但由于其与 LV-GCA 的炎症总负担相关，因此可能在监测疾病活动方面具有一定作用。这些发现需要在其他人群和更大的前瞻性研究中得到证实。
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