Rheumatology Unit, S. Giovanni Di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy.
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Immunol Res. 2024 Oct;72(5):1154-1160. doi: 10.1007/s12026-024-09518-0. Epub 2024 Aug 30.
In the recent EULAR recommendations, ultrasound examination is now recommended as a first-line imaging test in all patients with suspected giant cell arteritis (GCA) and the axillary arteries should be included in the standard exam. As an alternative to ultrasound evaluation, cranial and extracranial arteries can be examined using FDG-PET or MRI. The aim of our study was to observe in a retrospective case series whether there is a correlation between biomarkers and imaging activity in a population of patients followed in real life with GCA treated with prednisone (PDN) and tocilizumab (TCZ). We retrospectively enrolled 68 patients with newly diagnosed GCA between January 2020 and September 2021, followed in real life, who were examined at the Rheumatology Unit of the San Giovanni di Dio Hospital, Florence, Italy. Patients were evaluated at T0-T3-T6-T12-T18-T24 for the following blood tests: ESR, CRP, fibrinogen, platelet count, serum amyloid A (SAA), IL-6, and circulating calprotectin (MRP). Ultrasound examination of the temporal arteries and axillary arteries was assessed at T0 within 7 days of starting treatment with high-dose glucocorticoids and subsequently at T3-T6-T12-T18-T24. A scale from 0 to 3 with semi-quantitative tools (SUV max) was assessed at T0-T12-T24. The evaluation of the correlation coefficient between laboratory and imaging variables has shown that SAA and MRP have the most powerful correlation with the PET score (0.523 and 0.64), and MRP also has an excellent correlation coefficient with the Halo score (0.658). The evaluation of the ROC curves shows for a PET score 3 and SAA values higher than 26 mg/L, sensitivity of 81.5% and specificity of 84.1%, and for a PET score 3 and MRP values higher than 2.3 mcg/mL, sensitivity of 100% and specificity of 76.8%. In this study, we demonstrated that SAA and MRP can be useful as promising tools to detect GCA activity. The study demonstrates a good correlation between the two biomarkers and the imaging activity evaluated by the Halo and PET scores.
在最近的 EULAR 建议中，超声检查现在被推荐作为所有疑似巨细胞动脉炎 (GCA) 患者的一线影像学检查，并且腋动脉应包括在标准检查中。作为超声评估的替代方法，颅外和颅外动脉可以使用 FDG-PET 或 MRI 进行检查。我们的研究目的是在一项回顾性病例系列研究中观察，在使用泼尼松 (PDN) 和托珠单抗 (TCZ) 治疗的 GCA 患者的真实生活中，生物标志物与影像学活动之间是否存在相关性。我们回顾性纳入了 2020 年 1 月至 2021 年 9 月期间在意大利佛罗伦萨圣乔瓦尼迪迪奥医院风湿病科就诊的 68 例新诊断的 GCA 患者。患者在 T0-T3-T6-T12-T18-T24 时接受以下血液检查：ESR、CRP、纤维蛋白原、血小板计数、血清淀粉样蛋白 A (SAA)、IL-6 和循环钙卫蛋白 (MRP)。在开始使用大剂量糖皮质激素治疗后 7 天内的 T0 时评估颞动脉和腋动脉的超声检查，随后在 T3-T6-T12-T18-T24 时进行。使用半定量工具 (SUV max) 评估 T0-T12-T24 的 0 至 3 分。实验室和影像学变量之间的相关系数评估表明，SAA 和 MRP 与 PET 评分相关性最强 (0.523 和 0.64)，MRP 与 Halo 评分也具有极好的相关性系数 (0.658)。ROC 曲线的评估显示，对于 PET 评分 3 和 SAA 值高于 26mg/L，敏感性为 81.5%，特异性为 84.1%，对于 PET 评分 3 和 MRP 值高于 2.3 mcg/mL，敏感性为 100%，特异性为 76.8%。在这项研究中，我们证明了 SAA 和 MRP 可以作为检测 GCA 活性的有前途的工具。该研究表明，两种生物标志物与 Halo 和 PET 评分评估的影像学活动之间存在良好的相关性。
