• Walid Moudrous, Leo H Visser, Tansel Yilmaz, Marjan H Wieringa, Tim Alleman, Jörgen Rovers, Mark P W A Houben, Paula M Janssen, Johan J B Janssen, Pieter L Rensma, and J F BrekelmansGeertGDepartment of Neurology of the ETZ, St. Elisabeth Hospital, Tilburg, the Netherlands..
• Department of Neurology, Maasstad Hospital, Rotterdam, the Netherlands.
• Ann. Med. 2022 Dec 1; 54 (1): 277027762770-2776.

ObjectiveThe gold standard for diagnosis of giant cell arteritis (GCA) is a temporal artery biopsy (TAB). We sought for a clinical useful model to predict when an invasive TAB is not necessary to confirm GCA.MethodsA prospective cohort study was conducted with patients > 50 years with possible GCA, presenting with newly onset headache and/or visual loss. Demographical, clinical, laboratory findings and histological data were collected.ResultsFifty-six (70%) of the 94 patients showed 1 or more halos of the superficial temporal artery branches. Ultrasound-guided biopsy was positive in 28 patients (30%). Four independent variables predicted a positive TAB: weight loss, bilateral headache, positive halo sign and thrombocytosis. The ROC of the model had an area under the curve of 0.932 with a PPV of 83% and a NPV of 94%.ConclusionsWeight loss, bilateral headache, a positive halo sign with duplex and thrombocytosis are the most important clinical and laboratory predictors for GCA in a selected group of patients.SignificanceIn patients > 50 years presenting with new onset headache or visual loss with 3 or more of the above mentioned risk factors, a biopsy of the temporal artery is not needed to confirm the diagnosis GCA.KEY MESSAGESIn our study biopsy of the temporal artery was positive in 30% of the patients with possible GCAWeight loss, bilateral headache, a positive halo sign on duplex and thrombocytosis are predictors for GCAThe halo sign had a high sensitivity but a low specificity for a biopsy proven GCA.

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