Giant Cell Arteritis Diagnosis by Biopsy or Ultrasound: Are we Classifying a Homogeneous Population?

De Miguel E,Sanchez J,Monjo I,Fernandez E,Pablos JL,Almorza T

doi:10.35248/2161-1149.19.9.246

Abstract

Giant cell arteritis (GCA) is a granulomatous vasculitis with autoimmune origin that is defined by the presence of mononuclear cell infiltrates and the formation of giant cells. It appears in elderly patients and involves the aorta and its branches, particularly the superficial temporal artery. In these patients, rapid diagnosis and immediate initiation of treatment are essential to prevent vascular complications, particularly visual loss and ischemic stroke.

Highlights

The diagnosis of CGA is based fundamentally on the criteria of the American College of Rheumatology (ACR) published in 1990 [1], according to findings of the anamnesis, physical examination and laboratory tests, and on the temporal artery biopsy [2]
Giant cell arteritis (GCA) is a granulomatous vasculitis with autoimmune origin that is defined by the presence of mononuclear cell infiltrates and the formation of giant cells
Time has changed the acceptance of the value of ultrasound, from a residual value in the diagnosis of GCA in the first decade of this century, until the present when has been accepted as the technique of choice, in well- trained units, in the EULAR recommendations in the follow-up and diagnosis of large vessel vasculitis published in 2018 [9]

Summary

Introduction

The diagnosis of CGA is based fundamentally on the criteria of the American College of Rheumatology (ACR) published in 1990 [1], according to findings of the anamnesis, physical examination and laboratory tests (age of onset greater than or equal to 50 years, headache of recent onset, hypersensitivity of the temporal artery or decrease of the pulse and increase of the ESR to 50 mm/h or higher), and on the temporal artery biopsy [2]. The number of false negatives in the temporal artery biopsy varies according to the literature between 9 and 44% [3], according to diverse sources these rates can still be higher [4]. The causes of this variability of the biopsy in the negative cases are fundamentally three: the patchy and symmetric condition of the lesions, the surgical technique and the pathologist's interpretation. Experts recommend samples larger than 1 cm and choosing the clinically most symptomatic artery to improve sensitivity This low sensitivity of the biopsy justifies the search for new diagnostic methods, and this is where imaging techniques arise, especially colour Doppler ultrasound (CDUS)

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