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To develop and explore a protocol for using colour duplex sonography (CDS) in the routine care of GCA.We tested CDS of temporal arteries and axillary arteries (AXs) on consecutive patients with suspected or established GCA, between July 2014 and September 2016.We assessed 293 patients [age 72 (10), female/male 196/97], of whom 118 had clinically confirmed GCA. Seventy-three percent of patients had already received high-dose glucocorticoids (GCs) for 17 (33) days. Among new referrals with <7 days of GC treatment (n = 55), the sensitivity of CDS was 63.3% (95% CI: 44%, 80%), specificity 100% (95% CI: 83%, 100%), positive predictive value 100% and negative predictive value 64.5% (95% CI: 53%, 74%). Sensitivity rose to 81.8% in patients with jaw claudication and high inflammatory markers. During the observation period, the rate of temporal artery biopsies decreased from 72 (42%) to 36 (25%) (P = 0.002). CDS was positive in 21% of 89 follow-up scans in asymptomatic individuals, compared with 37% in patients experiencing clinical flares. Over time, the number of halos reduced; only new or flaring patients showed a halo in four or more sites. The diameter of axillary halos reduced from referral [1.6 (0.4) mm] to follow-up [1.4 (0.2) mm, P = 0.01] or flares [1.4 (0.2) mm, P = 0.02].CDS provides high positive predictive value for diagnosing GCA and allows for a significant reduction in temporal artery biopsies. We explored the role of CDS in detecting flares and demonstrated a relationship to the extent of the distribution of halos, but not to their size.

Original publication

DOI

10.1093/rheumatology/kex341

Type

Journal article

Journal

Rheumatology (Oxford, England)

Publication Date

01/2018

Volume

57

Pages

112 - 119

Addresses

Rheumatology Department, NDORMS, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.

Keywords

Scalp, Masticatory Muscles, Tongue, Axillary Artery, Temporal Arteries, Humans, Headache, Vision Disorders, Intermittent Claudication, Glucocorticoids, Ultrasonography, Ultrasonography, Doppler, Color, Sensitivity and Specificity, Cohort Studies, Aged, Aged, 80 and over, Middle Aged, Female, Male, Giant Cell Arteritis