Jasim Muhamad, Magan Priyan, Patel Ferin, Adizie Tochukwu, Senn Dhanuja
Rheumatology, New Cross Hospital, Wolverhampton, GBR.
General Practice, Russells Hall Hospital, Birmingham, GBR.
Cureus. 2022 Dec 8;14(12):e32310. doi: 10.7759/cureus.32310. eCollection 2022 Dec.
Giant cell arteritis (GCA) is the most common type of large vessel vasculitis. The diagnosis of GCA is often challenging and there is a difficult balance of over- and underinvestigation. There have been several proposed scoring systems to help clinicians risk stratify patients who may present with suspected GCA.
A retrospective cohort study was performed using electronic medical records of patients referred for a temporal artery biopsy (TAB) and temporal artery ultrasound scan (USS) for suspected GCA. All TABs performed at the Royal Wolverhampton NHS Trust between June 2014 and June 2018 and all USS procedures performed between January 2015 and January 2019 were analysed. Patients who undergo a USS for suspected GCA at our centre routinely have scanned bilateral temporal and axillary arteries. Patients were excluded if they already had a previous diagnosis of GCA (and the clinical question was suspected flare), or if there was insufficient information available.
The total number of patients who underwent a confirmatory diagnostic test (either TAB or USS) for suspected GCA was 187. Thirteen of these patients met the exclusion criteria, the remaining 174 patients were included for analysis. A total of 126 of 174 patients underwent a TAB and 63 of 174 had a USS performed; 15 of 174 who had both these were included in the USS cohort because for all these patients, the ultrasound was the first diagnostic test performed. Our results appear to closely mirror the original multi-centre results with regard to the prediction of biopsy-positive GCA, with the centiles closely following those in the inception cohort. Also, 0% of the 'low' risk probability biopsy cohort were misclassified; none had a positive biopsy. However, 8% of the low-risk-probability ultrasound cohort were misclassified, as two had a positive ultrasound.
Our study highlights that a probability score for GCA derived from a large multi-centre cohort of patients who were biopsy positive predicts ultrasound positivity with similar accuracy. Our work reveals that scoring systems are not infallible but can be helpful in guiding clinical decision making.
巨细胞动脉炎（GCA）是最常见的大血管血管炎类型。GCA的诊断往往具有挑战性，在过度检查和检查不足之间难以平衡。已经提出了几种评分系统来帮助临床医生对可能患有疑似GCA的患者进行风险分层。
采用回顾性队列研究，使用因疑似GCA而接受颞动脉活检（TAB）和颞动脉超声扫描（USS）的患者的电子病历。分析了2014年6月至2018年6月在皇家伍尔弗汉普顿国民保健服务信托基金进行的所有TAB以及2015年1月至2019年1月进行的所有USS检查。在我们中心因疑似GCA接受USS检查的患者常规扫描双侧颞动脉和腋动脉。如果患者先前已被诊断为GCA（临床问题为疑似复发）或信息不足，则将其排除。
因疑似GCA接受确诊诊断检查（TAB或USS）的患者总数为187例。其中13例患者符合排除标准，其余174例患者纳入分析。174例患者中共有126例接受了TAB，63例进行了USS检查；174例中同时进行这两项检查的15例被纳入USS队列，因为对于所有这些患者，超声是首次进行的诊断检查。在活检阳性GCA的预测方面，我们的结果似乎与最初的多中心结果非常相似，百分位数与初始队列中的百分位数密切相关。此外，“低”风险概率活检队列中0%被错误分类；没有人活检呈阳性。然而，低风险概率超声队列中有8%被错误分类，因为有两人超声检查呈阳性。
我们的研究强调，从大量活检阳性的多中心患者队列中得出的GCA概率评分预测超声阳性的准确性相似。我们的工作表明，评分系统并非万无一失，但有助于指导临床决策。
