Performance of Diagnostic Examinations for Giant Cell Arteritis and Subtypes: A Multicenter Japanese Study

This study aims to elucidate the diagnostic process of giant cell arteritis (GCA) by subtype in Japan.

This was a secondary analysis of a multicenter retrospective study of patients with GCA treated with tocilizumab. Patients were included in the cohort if a clinical diagnosis of GCA was made by a board-certified rheumatologist. Cranial GCA (C-GCA) was defined as a positive temporal artery biopsy (TAB), temporal artery ultrasound (TAU), or the presence of cranial manifestations. Large vessel GCA (LV-GCA) was defined by a positive computed tomography (CT), positron emission tomography (PET)-CT, or limb claudication attributable to GCA. We evaluated the diagnostic performance of each examination and assessed concordance between TAU and TAB. The diagnostic process was illustrated using flowcharts.

We identified 61 GCA patients, with a median age of 74 years; 40 were female. Among C-GCA patients, the positivity rates were 52.6% (20/38) for TAU, 70% (7/10) for magnetic resonance imaging (MRI), and 81.8% (36/44) for TAB. The positivity rates in LV-GCA were 81.5% (22/27) for CT and 100% (16/16) for PET-CT. Concordance between TAU and TAB varied considerably across institutions. The diagnostic workflow showed that patients with C-GCA typically underwent multiple diagnostic examinations, and most (83.3%) TAU-negative patients with C-GCA had either a positive head MRI or TAB.

This multicenter Japanese study demonstrated the low sensitivity of TAU for cranial GCA, with performance varying across institutions. Combining head MRI and TAB with TAU may improve the diagnosis of GCA in Japanese clinical practice.