Thielmann Lukas-Caspar, Findik-Kilinc Melike, Füeßl Louise, Lottspeich Christian, Löw Anja, Henke Teresa, Hasmann Sandra, Prearo Ilaria, von Bismarck Amanda, Reik Lilly Undine, Wirthmiller Tobias, Nützel Andreas, Mackert Marc J, Priglinger Siegfried, Schulz Heiko, Mayr Doris, Haas-Lützenberger Elisabeth, Gebhardt Christina, Schulze-Koops Hendrik, Czihal Michael
Division of Vascular Medicine, Medical Clinic and Policlinic IV, LMU University Hospital, 80336 Munich, Germany.
Interdisciplinary Sonography Center, Medical Clinic and Policlinic IV, LMU University Hospital, 80336 Munich, Germany.
J Clin Med. 2025 Mar 26;14(7):2254. doi: 10.3390/jcm14072254.
Early diagnosis of giant cell arteritis (GCA) is crucial to avoid loss of vision, but detailed headache characteristics of GCA have been poorly studied. Clinical prediction rules have shown promise in guiding management decisions in suspected GCA. This is a prospective, monocentric cohort study on patients ≥50 years of age with suspected GCA. The diagnostic efficacy and safety of a previously published prediction rule embedded in a stepwise diagnostic algorithm is compared to the final clinical diagnosis incorporating the results of temporal artery biopsy (TAB). The protocol of the ongoing study is presented in detail. Based on an interim analysis of the first 50 included patients, characteristics of cranial symptoms of patients with positive and negative TAB are compared, and a modification of the original prediction rule is presented. TAB was positive in 23 and negative in 26 cases. In one patient, the TAB specimen contained no arterial segment, so this patient was excluded from the interim analysis. Headache was more commonly located temporally and bilaterally. Cranial ischemic symptoms and superficial temporal artery-related symptoms were more common in patients with positive TAB. The quality and intensity of headaches did not differ significantly between groups. As the original prediction rule misclassified a single patient who eventually had a positive TAB, the clinical prediction rule was modified. Given the limited sensitivity and specificity of cranial symptoms, a stepwise diagnostic algorithm based on the modified prediction rule may facilitate clinical decision-making in suspected GCA.
巨细胞动脉炎（GCA）的早期诊断对于避免视力丧失至关重要，但GCA详细的头痛特征研究较少。临床预测规则在指导疑似GCA的管理决策方面已显示出前景。这是一项针对年龄≥50岁疑似GCA患者的前瞻性单中心队列研究。将先前发表的嵌入逐步诊断算法中的预测规则的诊断效能和安全性与结合颞动脉活检（TAB）结果的最终临床诊断进行比较。详细介绍了正在进行的研究方案。基于对首批纳入的50例患者的中期分析，比较了TAB阳性和阴性患者的颅部症状特征，并提出了对原始预测规则的修改。23例患者的TAB结果为阳性，26例为阴性。1例患者的TAB标本中没有动脉段，因此该患者被排除在中期分析之外。头痛更常见于颞部且为双侧性。颅部缺血症状和颞浅动脉相关症状在TAB阳性患者中更为常见。两组之间头痛的性质和强度没有显著差异。由于原始预测规则将1例最终TAB结果为阳性的患者错误分类，因此对临床预测规则进行了修改。鉴于颅部症状的敏感性和特异性有限，基于修改后的预测规则的逐步诊断算法可能有助于疑似GCA的临床决策。
