Atypical Signs and Symptoms of Giant Cell Arteritis: A Systematic Review.

BACKGROUND: Giant cell arteritis can present with atypical manifestations that delay treatment and risk severe complications. OBJECTIVES: To comprehensively describe all atypical signs/symptoms of giant cell arteritis. DESIGN: In this systematic review, we searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to October 2022. Primary research articles that included at least one participant with an atypical sign/symptom of biopsy-proven giant cell arteritis were included. Study screening and data extraction were performed in duplicate. The primary outcome was the proportion of participants with atypical giant cell arteritis features. Time to treatment was compared between participants with atypical giant features only and participants with both typical and atypical features. RESULTS: Of 21,828 screened records, 429 studies corresponding to 746 individuals (median [IQR] age 72 [IQR, 66-78] years, 63% female) with at least one atypical feature of GCA were included. Eighty-two percent had both atypical and at least one concurrent typical giant cell arteritis feature, whereas 18% of patients with atypical signs and symptoms only presented with atypical features. Patients with atypical symptoms presented to clinicians earlier than patients with typical features (p < 0.001). There was no difference between groups in proportion to elevated ESR and CRP (82.3% vs. 83.35%, p = 0.91) or mortality rate (8.2% vs. 10.8%, p = 0.42). Patients with atypical features only experienced greater delay in treatment initiation (p < 0.001). The most commonly reported atypical signs/symptoms were vertigo (11.9%), scalp necrosis/ulceration (7.9%), and dry cough (5.8%). CONCLUSIONS: Eighteen percent of biopsy-proven giant cell arteritis cases with at least one atypical feature have only atypical features and are more likely to experience delays in treatment. Clinicians should be aware of atypical signs/symptoms of giant cell arteritis and order inflammatory markers early to prevent giant cell arteritis-associated morbidity.

Use of immunosuppressants and biologics in giant cell arteritis: Recommendations of the French Study Group for Large Vessel Vasculitis (GEFA).

PURPOSE: An updated revision of the 2016 recommendations from the French Study Group for Large Vessel Vasculitis (GEFA) was needed to better delineate the place and management of immunosuppressants or biologics in giant cell arteritis (GCA). METHODS: A panel of 18 physicians, including internists and rheumatologists, constituted the task force of this project and drafted the recommendations. Twelve additional readers were asked to analyse and comment on the recommendations. Two face-to-face virtual meetings were held to discuss and validate the recommendations. Each member voted individually, and a>85% consensus was required to validate each recommendation. RESULTS: From the initial 6 questions, 26 recommendations were validated. The following main recommendations were validated. (1) Subcutaneous 162mg tocilizumab (TCZ) for at least 12months should be used first when glucocorticoid (GC)-sparing treatment is needed with the objective of discontinuing GCs within the subsequent 6months. (2) GCA patients who have experienced any of the following conditions must receive TCZ at GCA diagnosis with 6months of GC therapy: major cardiovascular event, osteoporosis with fracture, psychiatric event with GC use, complicated diabetes mellitus, or any previous>6months of GC treatment. (3) In patients in whom GC discontinuation is not possible after 12months of treatment because of persistent disease activity or in patients in whom GC-related adverse events are unacceptable, TCZ (or alternatively methotrexate) may be proposed. CONCLUSIONS: These recommendations were constructed based on the results of the published literature and the experts' experiences to standardise therapeutic practices in France. Further updates will likely be necessary following new publications.

Polymyalgia Rheumatica Following Influenza B Infection: A Case Report.

We describe a case of polymyalgia rheumatica (PMR) following an influenza B infection. The patient was a 71-year-old woman who developed a fever above 38.0°C and was diagnosed with influenza B, confirmed by a rapid antigen test. Although the fever resolved after three days, she continued to experience neck pain, back pain, and joint pain, particularly in both shoulders and hips. She also reported morning joint stiffness lasting for more than an hour and occasional low-grade fever. She presented to our hospital 25 days after the onset of symptoms. Blood tests revealed elevated C-reactive protein and erythrocyte sedimentation rate, but levels of creatine phosphokinase, rheumatoid factor, and anti-cyclic citrullinated peptide were not elevated. She was diagnosed with PMR and treated with prednisolone (PSL) 15 mg/day. The response to steroids was remarkably good, and PSL was tapered over six months. PMR is believed to result from an immune-mediated process and may be associated with certain human leukocyte antigen haplotypes. Additionally, PMR is sometimes preceded by an infection. To date, there have been very few reports suggesting a connection between influenza B and PMR, underscoring the need for further case accumulation.

French protocol for the diagnosis and management of giant cell arteritis.

Giant cell arteritis (GCA) is a large-vessel vasculitis that mainly affects women over fifty. GCA usually involves branches from the external carotid arteries, causing symptoms such as headaches, scalp tenderness, and jaw claudication. The most severe complication is ophthalmologic involvement, including acute anterior ischemic optic neuropathy and, less frequently, central retinal artery occlusion with a risk of permanent blindness. Approximately 40% of patients may have involvement of the aorta or its branches, which has a poor prognosis, although this is often asymptomatic at diagnosis. Diagnosis is largely based on imaging techniques such as FDG-PET combined with CT, CT angiography, or MRI angiography of the aorta and its branches. Polymyalgia rheumatica is associated with GCA in 30-50% of cases but may also occur independently. Treatment must be initiated urgently in the presence of ophthalmologic signs or when GCA is strongly suspected to prevent vision loss. The gold standard to confirm the diagnosis is temporal artery biopsy. However, Doppler ultrasound and vascular imaging are also reliable diagnostic techniques. Initially, high doses of corticosteroids like prednisone (40-80mg per day) are the mainstay of treatment. Tocilizumab can be discussed in combination with prednisone for corticosteroid sparing. Long-term management is essential, including monitoring for disease recurrence and corticosteroid-related side effects. General practitioners play a crucial role in early diagnosis, directing patients to specialized centres, and in managing ongoing treatment in collaboration with specialists. This collaboration is essential to address potential long-term complications such as cardiovascular events. They can occur five to ten years after the diagnosis of GCA even when the disease is no longer active, meaning that vigilant follow-up is required due to the patients' age and status.

18F-FDG-PET/CT Scan for Detection of Large Vessel Involvement in Giant Cell Arteritis: Arteser Spanish Registry.

Background/Objectives: Imaging studies have transformed the diagnosis of large vessel vasculitis (LVV) involvement in giant cell arteritis (GCA). A positron emission tomography/computed tomography (PET/CT) scan with 18-fluorodeoxyglucose (18F-FDG) has emerged as a valuable tool for assessing LVV. We aimed to determine the utility of an 18F-FDG-PET/CT scan in detecting LVV in GCA in the ARTESER registry. Methods: The ARTESER study is a large multicenter, retrospective, longitudinal, and observational study, promoted by the Spanish Society of Rheumatology. It included patients newly diagnosed with GCA across 26 tertiary hospitals from 1 June 2013 to 29 March 2019. Patients with a diagnosis of incidental GCA were included if they fulfilled specific criteria, including the ACR 1990 criteria, positive imaging examinations, or the expert clinical opinion of investigators. Differences between patients with positive and negative 18F-FDG-PET/CT scan results were analyzed using a bivariate model. A regression model assessed associations in patients with a positive scan, and the predictive capacity of the cumulative dose of glucocorticoids (GC) on PET scan outcomes was evaluated using ROC curve analysis. Results: Out of 1675 GCA patients included in the registry, 377 met the inclusion criteria of having an 18F-FDG-PET/CT scan. The majority were diagnosed with a cranial GCA phenotype, and 65% had LVV. The thoracic aorta was the most frequently affected. Cardiovascular disease, diabetes, and older age had a negative association with a positive scan outcome. The OR for having a positive 18F-FDG-PET/CTC scan was lower as the number of days increased. Depending on the cumulative dosage of the GC, the 18F-FDG-PET/CT scan showed an AUC of 0.74, with a Youden index > 60 mg/day. Conclusions: Younger patients showed a higher probability of presenting LVV as detected by the 18F-FDG-PET/CT scan. The timing of the examination and the cumulative dosage of the GC influenced the likelihood of a positive result, with earlier tests being more likely to detect inflammation.

Endovascular treatment for aggressive vertebrobasilar stenosis due to giant cell arteritis: illustrative cases.

BACKGROUND: Giant cell arteritis (GCA) infrequently presents with progressive symptomatic vertebrobasilar stenosis. Vertebrobasilar GCA is often refractory to medical treatments and can lead to short-term ischemic stroke recurrence, which is associated with a poor prognosis. Endovascular treatment (EVT) is a therapeutic option; however, the optimal timing and indications for its application remain unclear. OBSERVATIONS: This study reports two patients with vertebrobasilar GCA who exhibited repeated ischemic strokes in the vertebrobasilar territory, along with progressive severe stenosis and occlusion of the bilateral vertebral arteries, despite receiving medical therapy. They were successfully treated with balloon angioplasty, and there were no subsequent occurrences of stroke or restenosis. A review was conducted of six cases of vertebrobasilar GCA treated with EVT. All patients had bilateral lesions and experienced recurrent strokes within 30 days. Angiography suggested ischemic complications in vertebrobasilar GCA resulting from hemodynamic ischemia caused by stenosis rather than intradural vasculitis. The improved blood flow through EVT alleviated patient symptoms and prevented recurrent strokes. LESSONS: Some patients with vertebrobasilar GCA exhibit rapid stenosis progression and repeated hemodynamic ischemia despite medical therapy. EVT is a potential strategy for treating medically refractory vertebrobasilar GCA. Performing EVT prior to recurrent infarctions can lead to favorable outcomes. https://thejns.org/doi/10.3171/CASE24404.

Imaging Challenges and Developments in Large-vessel Vasculitis.

Vascular imaging is an integral part of large-vessel vasculitis (LVV) evaluation and management. Several imaging modalities are currently employed in clinical practice including vascular ultrasound, computed tomography angiography, MRI and magnetic resonance angiography, and 18F-fluorodeoxyglucose PET. Well-established roles for imaging in LVV include disease diagnosis and assessment of luminal lesions reflecting vascular damage. The ability of imaging to determine treatment response, monitor disease activity, and predict future arterial damage is an area of active research.

Multimodality imaging of pulmonary artery aneurysms due to giant cell arteritis: a case series.

Pulmonary artery aneurysms (PAAs) are rare, but important vascular phenomena with nonspecific signs and symptoms. While some patients remain asymptomatic, others manifest with serious symptoms such as chest pain, dyspnea, or hemoptysis. Often diagnosed incidentally, PAAs have various underlying etiologies, including congenital, acquired, and idiopathic. Giant cell arteritis (GCA) is a very rare cause of PAAs, with limited reported cases in the literature. This case series will review the clinical presentation, multimodality imaging, and management of four patients with isolated PAA due to GCA.

Age, anticoagulants, hypertension and cardiovascular genetic traits predict cranial ischaemic complications in patients with giant cell arteritis.

OBJECTIVES: This project aimed to determine whether cranial ischaemic complications at the presentation of giant cell arteritis (GCA) were associated with pre-existing cardiovascular (CV) risk factors, CV disease or genetic risk of CV-related traits. METHODS: 1946 GCA patients with clinicodemographic data at GCA presentation were included. Associations between pre-existing CV-related traits (including Polygenic Risk Scores (PRS) for CV traits) and cranial ischaemic complications were tested. A model for cranial ischaemic complications was optimised using an elastic net approach. Positional gene mapping of associated PRS was performed to improve biological understanding. RESULTS: In a sample of 1946 GCA patients (median age=71, 68.7% female), 17% had cranial ischaemic complications at presentation. In univariable analyses, 10 variables were associated with complications (likelihood-ratio test p≤0.05). In multivariable analysis, the two variables with the strongest effects, with or without PRS in the model, were anticoagulant therapy (adjusted OR (95% CI)=0.21 (0.05 to 0.62), p=4.95×10-3) and age (adjusted OR (95% CI)=1.60 (0.73 to 3.66), p=2.52×10-3, for ≥80 years versus <60 years). In sensitivity analyses omitting anticoagulant therapy from multivariable analysis, age and hypertension were associated with cranial ischaemic complications at presentation (hypertension: adjusted OR (95% CI)=1.35 (1.03 to 1.75), p=0.03). Positional gene mapping of an associated transient ischaemic attack PRS identified TEK, CD96 and MROH9 loci. CONCLUSION: Age and hypertension were risk factors for cranial ischaemic complications at GCA presentation, but in this dataset, anticoagulation appeared protective. Positional gene mapping suggested a role for immune and coagulation-related pathways in the pathogenesis of complications. Further studies are needed before implementation in clinical practice.

Giant cell arteritis (GCA) as a risk factor for seizures: a cohort study.

OBJECTIVES: The objective of this study was to assess the risk of seizures in Giant Cell Arteritis (GCA) patients in a large cohort of Israeli subjects, in comparison to matched controls. METHODS: Patients diagnosed with GCA between 2002 and 2017 were included. Controls were matched based on sex, age, socioeconomic status, country of birth, diabetes mellitus, and hypertension in a 4:1 ratio. Patients with seizure records prior to the study period were excluded. Hazard ratios for seizures was obtained by cox regression models. RESULTS: The study cohort was composed by 8,103 GCA patients and 32,412 matched controls. The GCA group included 5,535 women (68%), 2,644 patients born in Israel (33%), and 2,888 patients with low socioeconomic status (36%). The median age of this group was 71. During the followed cumulative person-years of 54,641 and 222,537 in the GCA and control group, respectively, 15.92 cases per 10,000 person-years was found in the GCA group, compared to 9.62 per 10,000 person-years in the controls. GCA was associated with seizures in the unadjusted (HR = 1.66, 95% CI [1.29 to 2.13]) and adjusted (HR = 1.67, 95% CI [1.3 to 2.14]) models. GCA was also associated with seizures after controlling for strokes (HR = 1.55, 95% CI [1.16 to 2.07]). CONCLUSION: According to this study, individuals with GCA are at a higher risk of developing seizures when compared to the general population. This increased risk is independent of their predisposition for stroke. One proposed mechanism is that the GCA pro-inflammatory state may decrease the neuronal threshold for depolarization.

Ultrasound in GCA: Halo Sign Quantification and Visual Symptoms, Systemic Inflammation and Relapse Risk.

Background: A sonographic scoring system, termed Halo count and Halo score, of temporal and axillary arteries (TAXA) in suspected giant cell arteritis (GCA) has been proposed for outcome prognostication. Method: We conducted a retrospective review into the relationship of Halo count and Halo score and clinical-laboratory parameters amongst patients diagnosed with GCA via our rapid-access pathway to determine whether these measures should form part of our local routine clinical practice. Result: This review of TAXA ultrasound (US) images in patients with diagnosed GCA did not identify any correlation between Halo count/score and ocular symptoms, jaw claudication, 6-month relapse risk or inflammatory markers. Conclusion: This suggests that further prospective evaluation of Halo count and -score is required before adopting these measures into routine US scanning of TAXA for suspected GCA.

FDG PET/CT in large vessel vasculitis.

Large vessel vasculitides (LVV) such as giant cell arteritis, Takayasu arteritis and aortitis/periaortitis are characterised by immune-mediated inflammation of medium to large arteries. Clinical disease manifestations can be non-specific and diagnostic imaging plays an important role in the diagnostic pathway. In recent years, FDG PET/CT has proven to be a powerful metabolic tool that can provide a wholed body, non-invasive assessment of vascular inflammation. This review outlines the clinical features of large vessel vasculitis and the closely related entity of polymyalgia rheumatica, summarises the evidence for FDG PET/CT in the assessment of these conditions, and provides guidance for patient preparation, image acquisition and interpretation.

A History of Polymyalgia Rheumatica: A Narrative Review.

Polymyalgia rheumatica (PMR) is characterised by stiffness and pain in the shoulders, hips, and neck and presents most commonly in the eighth decade. It can coexist with giant cell arteritis and the two diseases may share some pathophysiological mechanisms. This narrative review considers present-day ideas about PMR in a historical context, from the first names and descriptions of this disease entity, via successive generations of classification criteria sets, and finally to implications for clinical diagnosis. The characteristic distribution of musculoskeletal inflammation in PMR, and its relationship to vasculitic and synovitic diseases, have framed the way that PMR is described, classified, diagnosed and treated. A response to glucocorticoids is not specific to PMR and so it is important for rheumatologists to support general practitioners in making a definite diagnosis. Multi-stakeholder collaboration will improve current pathways for fast, accurate diagnosis and safe and effective treatment.

Epidemiology of large vasculitis in Shanghai, China: A 10-year multicenter hospital-based study and systematic review.

BACKGROUND: Takayasu arteritis (TAK) and giant cell arteritis (GCA) are two major large vessel vasculitis, with varied epidemiology by geographical location, age, and race. However, the epidemiological data in Chinese population is rarely reported. This study estimated the epidemiology of TAK and GCA in Shanghainese individuals residing in China over a 10-year period. METHODS: TAK data for individuals over 16 years and GCA data for individuals over 50 years were retrieved from 38 comprehensive hospitals in Shanghai, China through the electronic medical record systems between January 1, 2011, and December 31, 2020. A systematic literature review was performed to determine the global distribution of TAK and GCA by searching PubMed, Ovid-Medline, Excerpta Medica Database (EMBASE), and Web of Science. RESULTS: In 173 identified TAK cases (67% females; mean age, 46 ± 15 years), the period prevalence was 11.72 cases per million, and the mean annual incidence was 1.33 cases per million. The highest prevalence (17.74 cases per million) and incidence (1.71 cases per million) were observed in the 16- to 34-year-old age group. In 92 identified GCA cases (56% females; age, >50 years), the period prevalence was 2.73 cases per 100 000 persons, and the mean annual incidence was 1.91 cases per 100 000 persons. Meta-analysis of the incidence study of TAK and GCA showed that the pooled incidence rate of TAK and GCA was 1.29 per million and 15.48 per 100 000 person-years, respectively. Subgroup analysis showed that the incidence of TAK was significantly higher in Asia than in other regions, while the incidence of GCA was higher in Europe, especially North Europe. CONCLUSION: The epidemiological patterns of TAK and GCA were comprehensively mapped globally and locally, in Shanghai, China.

Serial assessment of ultrasound sensitivity and scores in patients with giant cell arteritis before and 3 and 10 days after treatment.

OBJECTIVES: To evaluate sensitivity and scores of vascular ultrasound (US) before and after initiating glucocorticoid (GC) treatment in patients with new-onset giant cell arteritis (GCA). METHODS: Treatment-naïve patients with GCA were prospectively included. 18F-FDG PET/CT, US and temporal artery (TA) biopsy were performed in all patients. US was repeated 3 and 10 days after GC commencement. Intima-media thickness and presence of halo signs were assessed. Sonographers were unblinded to clinical data. The OMERACT GCA Ultrasonography score (OGUS) and halo count (HC) were calculated. RESULTS: Forty-eight patients were included. Before GC exposure, US sensitivity was 94% (95% CI: 83-99), 73% (95% CI: 58-85) and 71% (95% CI: 56-83) when assessing all vessels, TAs, and large vessels (LVs), respectively. At day 3 and 10, overall US sensitivity was 92% (95% CI: 78-98, p= 0.16) and 83% (95% CI: 69-92, p= 0.10), respectively. At day 10, TA-US and LV-US sensitivity was 53% (95% CI: 38-68, p< 0.01), and 60% (95% CI: 44-74, p= 0.13), respectively. Median OGUS decreased from 1.06 (IQR 0.83-1.24)-0.95 (IQR 0.78-1.14, p< 0.01), and 0.90 (IQR 0.73-1.01, p< 0.001) after 3 and 10 days, respectively. Median HC decreased from 3 (IQR 2-5)-2 (IQR 1-4, p< 0.01) after 10 days. CONCLUSION: The vasculitic US findings expressed by OGUS diminish after 3 days of GC treatment. TA-US sensitivity decreased after 10 days, whereas LV-US was less likely to change, highlighting the importance of LV-assessment. Consistent with the EULAR recommendations, these findings encourage prompt US assessment, preferably within 3 days, to ensure an accurate diagnosis.

Safety and Efficacy of Long-Term Tocilizumab in a Cohort of Patients with Giant Cell Arteritis: An Italian Monocentric Retrospective Study.

Objective: Tocilizumab (TCZ) is the only biologic drug approved for the treatment of giant cell arteritis (GCA), having clinical trials and real-life studies proved its efficacy and safety. However, the optimal duration of the treatment has yet to be determined, being its early interruption associated with an increased risk of relapse. Conversely, prolonged schemes of therapy may rise safety concerns. The aim of the study was to evaluate the incidence of adverse events (AEs) and remission/relapse rate in a cohort of GCA patients treated with TCZ and an accelerated steroid tapering scheme, followed for 24 months. Methods: We retrospectively included patients referring to our clinic from January 2019 to November 2021 who were diagnosed with GCA and started subcutaneous TCZ treatment (162 mg/week). They also received up to 62,5 mg of prednisone (PDN), tapered following an accelerated six-month scheme. Results: We collected 38 patients, with a mean age of 76,4 years, treated with TCZ for an average of 22,3 months. AEs occurred in 11 (29%) subjects, and only one serious AE was reported; 7 (18%) patients permanently discontinued TCZ. At the end of the follow-up, all the patients continuing treatment showed clinical remission, with a PDN dosage <5mg. We registered 3 (8%) minor relapses under TCZ, after an average of 15 months. Conclusion: Our data support the evidence of a safe and effective long-term use of TCZ in GCA patients, especially when combined with moderate GCs doses for the shortest possible duration.

The incidence of vasculitides in Israel from 2007 to 2021 and during the COVID-19 pandemic.

Background: The incidence of various types of vasculitis conditions over time, specifically during coronavirus disease 2019 (COVID-19), is unknown. Objectives: We aimed to assess recent trends in vasculitides and the effect of the COVID-19 pandemic on these trends. Design: We conducted a retrospective analysis of Israel's largest Health Maintenance Organization, which covers over 4.7 million patients and represents 55% of the country. Methods: We calculated the age- and sex-adjusted incidence of giant cell arteritis (GCA), Takayasu, ANCA-associated vasculitis (AAV), IgA vasculitis, cryoglobulinemia, and Behcet's disease (BD) during 2007-2021. We analyzed associations of COVID-19 with the incidence of each of the examined conditions. Results: During 2007-2021, the adjusted annual incidence decreased from 7.9 (95% confidence interval (CI) 3.5-17.9) to 1.5 (95% CI 0.7-3.6) per 100,000 for GCA, from 5.2 (95% CI 2.7-11.1) to 1.5 (95% CI 0.7-3.3) per million for IgA vasculitis, and from 6.3 (95% CI 3.0-13.5) to 1.0 (0.5-2.5) per 100,000 for BD. The relative risks for these conditions decreased: 0.92 (95% CI 0.91-0.93), 0.93 (95% CI 0.89-0.98), and 0.90 (95% CI 0.85-0.94), respectively. The incidences of Takayasu, AAV, and cryoglobulinemia remained unchanged. The COVID-19 pandemic was not associated with changes in the incidence of any examined vasculitides. Conclusion: The incidences of GCA, IgA vasculitis, and BD decreased substantially in Israel during 15 years and were unaffected by the COVID-19 pandemic. Future studies should focus on possible environmental contributions to these findings.

Vasculitis associated with VEXAS syndrome.

OBJECTIVES: To define the prevalence, distribution, and characteristics of patients with VEXAS who have confirmed vasculitis. METHODS: Patients with VEXAS syndrome, verified by positive UBA1 mutation, were included. Chart review was performed to identify. PATIENT: characteristics and outcomes. Vasculitis diagnosis was based on either histopathology showing vascular inflammation or non-invasive angiography findings. Summary statistics were calculated. RESULTS: Eighty-nine patients met inclusion criteria. All were male with a median age of onset of 66.9 years (IQR 60.1, 72.7). Median (IQR) follow up was 3.8(2.2-5.5) years during which 21 patients (23.6%) had evidence of vasculitis. Vasculitis subtypes included small vessel vasculitis (19.1%), cutaneous medium vessel vasculitis (2.2%), and large vessel vasculitis (2.2%). No patient had more than one vessel size involved. Histopathology in small vessel vasculitis patients was consistent with cutaneous leukocytoclastic vasculitis in the majority, though one patient had leukocytoclastic peritubular capillaritis on renal biopsy. Cranial symptoms (headache, vision changes, or jaw pain) were noted in 18.0%. Two additional patients not experiencing cranial symptoms exhibited large vessel involvement with confirmed carotid thickening on non-invasive angiography; one of these had a positive temporal artery biopsy. CONCLUSION: VEXAS syndrome manifests as a variable vessel vasculitis in a quarter of patients, with cutaneous small and medium vessel involvement being particularly common. Some patients may have positive ANCA serologies or even renal vasculitis leading to misdiagnosis. Cranial symptoms are common and may mimic giant cell arteritis, though documented large vessel inflammation is rare.

A Novel Ultrasound Finding for the Diagnosis of Giant Cell Arteritis: Comparison With Temporal Artery Biopsy Findings.

Hypoechoic halo is a typical ultrasound finding in giant cell arteritis (GCA), but it may be a false positive due to arteriosclerosis. Therefore, we focused on the segmental distribution of GCA lesions, defined the luminal irregularity in long-axis images as the string of beads sign, and examined its diagnostic ability. As a result, the C-statistic of hypoechoic halo and string of beads sign was better than that of hypoechoic halo alone (1.00 vs. 0.89). Based on the above, the diagnostic ability of GCA can be improved by adding the string of beads sign to the conventional hypoechoic halo.