Ultrasound of proximal upper extremity arteries to increase the diagnostic yield in large-vessel giant cell arteritis

Abstract

Objective: To describe characteristic ultrasound findings and clinical features of patients with newly diagnosed cranial and large-vessel (LV) GCA in a specialized ultrasound clinic.

Methods: This case-control study includes all consecutive patients between 1997 and 2006 with newly diagnosed GCA. Duplex ultrasound of the temporal, subclavian, axillary and proximal brachial arteries was performed in all patients with suspected temporal arteritis, PMR, arm claudication, unclear inflammation or pyrexia of unknown origin (PUO).

Results: In 53 of 176 patients, ultrasound depicted characteristic vasculitic homogeneous wall swelling of the axillary, subclavian and/or proximal brachial arteries. These were affected in 98, 61 and 21%, respectively, in the 53 patients. The findings were bilateral in 79%. Axillary arteries were stenotic or occluded in 51 and 2% and temporal artery ultrasound and histology were positive in 62 and 67% of LV-GCA cases, respectively. A significantly greater number of LV-GCA patients were female (83 vs 65%) and younger (mean 66 vs 72 yrs) as compared with those without proximal arm involvement. Headaches (38 vs 75%), jaw claudication (24 vs 48%) and anterior ischaemic optic neuropathy (4 vs 19%) occurred significantly less frequently. The median time until diagnosis was significantly longer (31 vs 8 weeks). ESR and presence of PMR were similar in both groups.

Conclusions: Performing axillary artery ultrasound in all patients with suspected temporal arteritis, PMR, arm claudication, unclear inflammation or PUO increases the diagnostic yield for LV-GCA. Patients with LV-GCA differ from those without arm involvement.