A New Look into Ultrasound of the Facial and Subclavian Arteries in Patients Suspected with GCA: A Real-World Assessment

Objectives In diagnosing giant cell arteritis (GCA), Canadian rheumatologists have extensive experience in using Doppler ultrasonography (US), fueling the debate about favoring it over the standard temporal artery biopsy. It remains unclear whether evaluating extracranial arteries in addition to temporal and axillary arteries significantly improves the diagnostic threshold.[1] The primary objective was to analyze the pattern of US abnormalities in GCA and test the benefit of adding facial and subclavian arteries in the GCA assessment. The secondary objective was to evaluate the effect of prior glucocorticoid therapy on negating US findings. Methods Patients who underwent US assessment at the Centre Hospitalier Universitaire de Sherbrooke between 2021 and 2022 were included in the study. Arteries findings, symptoms, steroid treatment and the suggested diagnosis were written in the report, which we contrasted with the diagnosis recorded by the referred rheumatologist. Other clinical data and investigations done by the primary clinician were collected descriptively through the patient chart. Discrimination estimates were then calculated according to the artery findings. Results Most of the 51 subjects in this study were female aged 76 years old and 72,6% had already started a steroid treatment before the US. 19 had positive US findings, with the temporal artery making up the most positive cases. More patients had been diagnosed with GCA than positive ultrasound findings, which are explained by later investigations, such as a biopsy and PET scans. Sensitivity, specificity, positive predictive and negative predictive value were comparable for most combinations of surveyed arteries: 72.0%, 100%, 100% and 78.8% respectively. Adding facial or subclavian arteries to the standard temporal and axillary arteries evaluation did not improve biostatistical parameters. When comparing those with halo signs in the US to those without, 89.5% of the former and 62.5% of the latter were on corticosteroids, showing a p-value < 0.05. Conclusion Our study suggests that there was no improvement in the sensitivity, specificity, PPV and NPV when adding facial and/or subclavian arteries to the conventional temporal and axillary arteries. Our overall findings support previously reported biostatistics and the role US in GCA. The delay of active corticosteroid treatment for GCA can impact the US evaluation. Further research on the matter in a more controlled environment will contribute to the advancement of the use of US in rheumatology. [1.] Duftner C. RMD Open 2018;4(1):e000612.

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