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Published on: February 8, 2019
Prognostic value of quantifying vascular inflammation through ultrasound in patients with giant cell arteritis: the
Juan Molina-Collada1, Sharon Cowley2, Colm Kirby2
1Department of Rheumatology, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). Universidad Complutense de Madrid, Madrid, Spain.
Insights
Ultrasound imaging of vascular inflammation can predict relapses in giant cell arteritis (GCA). Higher OMERACT GCA Ultrasonographic Score (OGUS) values at baseline, 1, and 3 months indicate a greater risk of GCA relapse.
Area of Science:
- Rheumatology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large arteries.
- Predicting clinical relapse in GCA is crucial for timely treatment adjustments.
- Current methods for monitoring GCA activity have limitations.
Purpose of the Study:
- To evaluate the prognostic capability of ultrasound-assessed vascular inflammation for predicting GCA relapses.
- To determine the association between the OMERACT GCA Ultrasonographic Score (OGUS) and the risk of clinical relapse in GCA patients.
Main Methods:
- Prospective, international, multicentre observational study (MAGiCUS project) of newly diagnosed GCA patients.
- Serial ultrasound examinations of temporal and axillary arteries at baseline and 1, 3, 6, 12 months.
- Quantification of vascular inflammation using the OGUS score; primary outcome was clinical relapse between 6-12 months.
Main Results:
- 31 out of 156 (19.9%) GCA patients experienced a relapse.
- Higher baseline OGUS scores were significantly associated with relapse (p < 0.001).
- Increased OGUS at 1 month (OR 1.37) and 3 months (OR 1.51) also predicted relapse, with AUCs ranging from 0.67 to 0.74.
Conclusions:
- Ultrasound-based quantification of vascular inflammation (OGUS) demonstrates significant prognostic value in GCA.
- Elevated OGUS scores at baseline, 1 month, and 3 months are linked to a higher likelihood of clinical relapse.
- Ultrasonography offers a valuable tool for monitoring disease activity and predicting relapse risk in GCA patients.
Objectives:
To assess the prognostic value of ultrasound-based quantification of vascular inflammation for predicting relapses in giant cell arteritis (GCA).
Methods:
The Monitoring Activity of GCA through UltraSound (MAGiCUS) project is an international, multicentre, prospective, observational study including newly diagnosed GCA patients. Ultrasound of temporal and axillary arteries was conducted at baseline, 1, 3, 6 and 12 months. Vascular inflammation was quantified using the OMERACT GCA Ultrasonographic Score (OGUS). The primary outcome was the occurrence of the first clinical relapse between 6 and 12 months.
Results:
Among 156 GCA patients from 19 centres, 31 (19.9%) experienced a relapse. In patients without a relapse, OGUS was significantly lower at all follow-up visits than baseline (-0.15 to -0.35). Baseline OGUS was significantly higher in relapsing patients (1.58 vs 1.16, P < 0.001). In multivariate analysis, an increase in 0.1 units in baseline OGUS was associated with relapse (odds ratio [OR] 1.19; 95% CI: 1.08, 1.34). This association remained significant for 0.1 increases in OGUS at 1 month (OR 1.37; 95% CI: 1.17, 1.66) and at 3 months (OR 1.51; 95% CI: 1.20, 1.98). The areas under the receiver operating characteristic curve for predicting relapse were 0.70 (95% CI: 0.58, 0.80) for baseline OGUS, 0.74 (95% CI: 0.60, 0.85) at 1 month, and 0.67 (95% CI: 0.56, 0.78) at 3 months.
Conclusion:
Ultrasound-based quantification of vascular inflammation has prognostic value for predicting relapses during follow-up in GCA. Higher baseline, 1-month and 3-months OGUS are associated with an increased probability of clinical relapse.
