Department of Internal Medicine and Hematology, Centre Hospitalier Rochefort, Rochefort, France (G.Denis, C.D.).
Department of Internal and Vascular Medicine, l'Institut du Thorax, INSERM UMR 1087/CNRS UMR 6291, Nantes; and Team III Vascular & Pulmonary Diseases, Nantes Université, CHU Nantes, Nantes, France (O.E., C.A.-B., A.Raimbeau, G.G.).
Ann Intern Med. 2024 Jun;177(6):729-737. doi: 10.7326/M23-3417. Epub 2024 May 7.
Giant cell arteritis (GCA) is the most prevalent systemic vasculitis in people older than 50 years. Any delay in diagnosis impairs patients' quality of life and can lead to permanent damage, particularly vision loss.
To evaluate a diagnostic strategy for GCA using color Doppler ultrasound of the temporal artery as a first-line diagnostic test, temporal artery biopsy (TAB) as a secondary test, and physician expertise as the reference method.
Prospective multicenter study with a 2-year follow-up. (ClinicalTrials.gov: NCT02703922).
Patients were referred by their general practitioner or ophthalmologist to a physician with extensive experience in GCA diagnosis and management in one of the participating centers: 4 general and 2 university hospitals.
165 patients with high clinical suspicion of GCA, aged 79 years (IQR, 73 to 85 years).
The diagnostic procedure was ultrasound, performed less than 7 days after initiation of corticosteroid therapy. Only ultrasound-negative patients underwent TAB.
Bilateral temporal halo signs seen on ultrasound were considered positive. Ultrasound and TAB results were compared with physician-diagnosed GCA based on clinical findings and other imaging.
Diagnosis of GCA was confirmed in 44%, 17%, and 21% of patients by ultrasound, TAB, and clinical expertise and/or other imaging tests, respectively. Their diagnosis remained unchanged at 1 month, and 2 years for those with available follow-up data. An alternative diagnosis was made in 18% of patients. The proportion of ultrasound-positive patients among patients with a clinical GCA diagnosis was 54% (95% CI, 45% to 62%).
Small sample size, no blinding of ultrasound and TAB results, lack of an objective gold-standard comparator, and single diagnostic strategy.
By using ultrasound of the temporal arteries as a first-line diagnostic tool in patients with high clinical suspicion of GCA, further diagnostic tests for patients with positive ultrasound were avoided.
Tender "Recherche CH-CHU Poitou-Charentes 2014."
巨细胞动脉炎（GCA）是 50 岁以上人群中最常见的系统性血管炎。任何诊断延迟都会降低患者的生活质量，并可能导致永久性损伤，特别是视力丧失。
评估一种使用颞动脉彩色多普勒超声作为一线诊断测试、颞动脉活检（TAB）作为二线测试、并以医生专业知识作为参考方法的 GCA 诊断策略。
前瞻性多中心研究，随访 2 年。（ClinicalTrials.gov：NCT02703922）。
患者由他们的全科医生或眼科医生转介到参与中心之一的具有丰富 GCA 诊断和管理经验的医生处：4 家综合医院和 2 家大学医院。
165 例高度怀疑患有 GCA 的患者，年龄 79 岁（IQR，73 至 85 岁）。
诊断程序是超声检查，在开始皮质类固醇治疗后不到 7 天进行。只有超声阴性的患者进行 TAB。
超声上双侧颞动脉晕征阳性被认为是阳性。超声和 TAB 的结果与基于临床发现和其他影像学的医生诊断的 GCA 进行比较。
根据临床发现和其他影像学检查，分别有 44%、17%和 21%的患者通过超声、TAB 和临床专业知识和/或其他影像学检查确诊为 GCA。在 1 个月和 2 年时，有可用随访数据的患者的诊断仍未改变。在 18%的患者中做出了替代诊断。在有临床 GCA 诊断的患者中，超声阳性患者的比例为 54%（95%CI，45%至 62%）。
样本量小，超声和 TAB 结果未设盲，缺乏客观的金标准对照，以及单一的诊断策略。
通过在高度怀疑患有 GCA 的患者中使用颞动脉超声作为一线诊断工具，可以避免对超声阳性患者进行进一步的诊断测试。
“2014 年 Poitou-Charentes 大区-CHU 招标”。
