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Published on: February 8, 2019
A prospective cohort study evaluating the role of quantifying sonographic inflammatory changes in GCA
Colm Kirby1,2, Danielle Molloy1,2, Sharon Cowley1,2
1Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland.
Insights
Vascular ultrasound (VUS) scores, particularly the OMERACT GCA US Score (OGUS), effectively predict adverse events in Giant Cell Arteritis (GCA). These VUS quantification scores show promise as biomarkers for GCA management and clinical trials.
Area of Science:
- Rheumatology
- Medical Imaging
- Clinical Diagnostics
Background:
- Vascular ultrasound (VUS) is established for diagnosing Giant Cell Arteritis (GCA).
- The utility of VUS in monitoring GCA disease progression and predicting patient outcomes requires further definition.
Purpose of the Study:
- To evaluate the role of sonographic vasculitis quantification in GCA diagnosis and management.
- To assess longitudinal trends and normalization of VUS parameters.
- To determine patient factors predicting VUS outcomes and adverse events.
Main Methods:
- Prospective cohort study of GCA patients.
- Comparison of intima-media thickness (IMT), Halo Count (HC), Halo Score (HS), and OMERACT GCA US Score (OGUS) over 12 months.
- Correlation and AUC analyses to identify predictors of VUS outcomes and adverse events.
Main Results:
- Significant declines in mean HC, HS, IMT, and OGUS observed over 12 months.
- Normalization of HC, HS, and OGUS achieved by 6 months in a substantial proportion of patients.
- VUS scores, especially OGUS, demonstrated superior predictive value for adverse events compared to clinical and laboratory parameters.
Conclusions:
- VUS quantification scores, particularly OGUS, are validated biomarkers for GCA in a prospective cohort.
- These sonographic measures outperform clinical variables in predicting adverse events.
- VUS quantification scores hold potential as key outcome variables in GCA clinical trials.
Objectives:
Vascular ultrasound (VUS) is a well-validated tool for diagnosing GCA [1]. The role of VUS in prognostication and disease-monitoring remains to be defined.
Methods:
This study compares intima-media thickness (IMT), Halo Count (HC), Halo Score (HS) and OMERACT GCA US Score (OGUS) at multiple time points in a prospective cohort of GCA patients to evaluate the role of sonographic vasculitis quantification in the diagnosis and management of GCA. Longitudinal trends and time-to-normalization of HC, HS and OGUS were evaluated. Correlation coefficients, AUC analysis and DeLong test were used to determine which patient factors may predict VUS outcomes and which patient factors are predictive of adverse events.
Results:
Forty-eight of 50 patients were followed up at 6 months and 27 at 12 months. Mean HC, HS, IMT and OGUS all declined significantly over 12 months. Of 48 patients, HC, HS and OGUS normalized in 21, 32 and 39 patients, respectively, by 6 months. Fulfilling 2022 ACR/EULAR Classification Criteria showed moderate correlation with baseline HC, HS and OGUS with higher classification criteria scores showing strong correlation with higher VUS outcome scores. HC, HS and OGUS were superior to all clinical and laboratory parameters for predicting future adverse events with OGUS outperforming HC and HS.
Conclusion:
VUS quantification scores performed better than other clinical variables in predicting future adverse events in GCA and OGUS is validated in a prospective cohort. These data suggest that VUS quantification scores are candidate biomarkers for GCA and may be important outcome variables in clinical trials.
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