• Guillaume Denis, Olivier Espitia, Caroline Allix-Béguec, Céline Dieval, Fanny Lorcerie, Bruno Gombert, Xavier Pouget-Abadie, Claire Toquet, Christian Agard, Alizée Raimbeau, Giovanni Gautier, Jean-Michel Goujon, Géraldine Durand, Cécile Thollot-Karolewicz, Christian Lormeau, Aurélie Grados, Anne Grenot-Mercier, Rony El-Khoury, Agnès Riche, Florence Hospital, Sebastien Visee, Marie-Luce Auriault, Cédric Landron, Mickaël Martin, and Christophe Roncato.
• Department of Internal Medicine and Hematology, Centre Hospitalier Rochefort, Rochefort, France (G.Denis, C.D.).
• Ann. Intern. Med. 2024 Jun 1; 177 (6): 729737729-737.

BackgroundGiant cell arteritis (GCA) is the most prevalent systemic vasculitis in people older than 50 years. Any delay in diagnosis impairs patients' quality of life and can lead to permanent damage, particularly vision loss.ObjectiveTo evaluate a diagnostic strategy for GCA using color Doppler ultrasound of the temporal artery as a first-line diagnostic test, temporal artery biopsy (TAB) as a secondary test, and physician expertise as the reference method.DesignProspective multicenter study with a 2-year follow-up. (ClinicalTrials.gov: NCT02703922).SettingPatients were referred by their general practitioner or ophthalmologist to a physician with extensive experience in GCA diagnosis and management in one of the participating centers: 4 general and 2 university hospitals.Patients165 patients with high clinical suspicion of GCA, aged 79 years (IQR, 73 to 85 years).InterventionThe diagnostic procedure was ultrasound, performed less than 7 days after initiation of corticosteroid therapy. Only ultrasound-negative patients underwent TAB.MeasurementsBilateral temporal halo signs seen on ultrasound were considered positive. Ultrasound and TAB results were compared with physician-diagnosed GCA based on clinical findings and other imaging.ResultsDiagnosis of GCA was confirmed in 44%, 17%, and 21% of patients by ultrasound, TAB, and clinical expertise and/or other imaging tests, respectively. Their diagnosis remained unchanged at 1 month, and 2 years for those with available follow-up data. An alternative diagnosis was made in 18% of patients. The proportion of ultrasound-positive patients among patients with a clinical GCA diagnosis was 54% (95% CI, 45% to 62%).LimitationSmall sample size, no blinding of ultrasound and TAB results, lack of an objective gold-standard comparator, and single diagnostic strategy.ConclusionBy using ultrasound of the temporal arteries as a first-line diagnostic tool in patients with high clinical suspicion of GCA, further diagnostic tests for patients with positive ultrasound were avoided.Primary Funding SourceTender "Recherche CH-CHU Poitou-Charentes 2014."

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