Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan.
Mod Rheumatol Case Rep. 2023 Dec 29;8(1):112-116. doi: 10.1093/mrcr/rxad046.
The European League Against Rheumatism and the American College of Rheumatology have stated that the halo sign on vascular ultrasonography (v-US) is relevant in diagnosing giant cell arteritis (GCA) and is equivalent to temporal artery biopsy. However, there are only a few reports about transitions in v-US findings after glucocorticoid (GC) therapy. We report the transitions in the v-US findings in a case of GCA after GC therapy. The patient had rapidly progressive symptoms, and there were concerns about blindness. After GC therapy, we first observed improvement in headache and visual impairment symptoms within 1 week, followed by rapid improvement in laboratory findings within 2 weeks. Subsequently, there were improvements in v-US findings after more than 2 months. In conclusion, these findings showed a dissociation between improvements in clinical symptoms and v-US findings of the temporal artery. Additionally, this case suggests that regular examination of v-US findings is useful in evaluating GCA with evident vascular wall thickness before GC therapy.
欧洲抗风湿病联盟和美国风湿病学会已经指出，血管超声（v-US）上的晕征与巨细胞动脉炎（GCA）的诊断相关，与颞动脉活检相当。然而，关于糖皮质激素（GC）治疗后 v-US 发现的转变仅有少数报道。我们报告了一例 GCA 患者在 GC 治疗后的 v-US 发现的转变。该患者有快速进展的症状，并且存在失明的风险。GC 治疗后，我们首先观察到在 1 周内头痛和视力障碍症状改善，随后在 2 周内实验室检查结果迅速改善。随后，在 2 个月后 v-US 发现有改善。总之，这些发现表明临床症状和颞动脉 v-US 发现之间的改善存在分离。此外，该病例表明，在 GC 治疗前，对于血管壁厚度明显的 GCA，定期检查 v-US 发现有助于评估。
