Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA)
Abstract Background Giant cell arteritis (GCA) is a common large vessel vasculitis of the elderly, often associated with sight loss. Glucocorticoids (GC remain the mainstay of treatment, although biologic treatments have been approved. Biomarkers predicting disease severity, relapse rates and damage...
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| Format: | Article |
| Language: | English |
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BMC
2020-08-01
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| Series: | BMC Rheumatology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41927-020-00136-5 |
| _version_ | 1818159474160959488 |
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| author | Alwin Sebastian Kornelis S. M. van der Geest Fiona Coath Prisca Gondo Abdul Kayani Craig Mackerness Bernard Hadebe Sue Innes Jo Jackson Bhaskar Dasgupta |
| author_facet | Alwin Sebastian Kornelis S. M. van der Geest Fiona Coath Prisca Gondo Abdul Kayani Craig Mackerness Bernard Hadebe Sue Innes Jo Jackson Bhaskar Dasgupta |
| author_sort | Alwin Sebastian |
| collection | DOAJ |
| description | Abstract Background Giant cell arteritis (GCA) is a common large vessel vasculitis of the elderly, often associated with sight loss. Glucocorticoids (GC remain the mainstay of treatment, although biologic treatments have been approved. Biomarkers predicting disease severity, relapse rates and damage are lacking in GCA. EULAR recommends ultrasound (US) as the first investigation for suspected GCA. The cardinal US finding, a non-compressible halo, is currently categorised as either negative or positive. However, the extent and severity of this finding may vary. In this study, we hypothesise whether the extent and severity of the halo sign [calculated as a single composite Halo score (HS)] of temporal and axillary arteries may be of diagnostic, prognostic and monitoring importance; whether baseline HS is linked to disease outcomes, relapses and damage; whether HS can stratify GCA patients for individual treatment needs; whether HS can function as an objective monitoring tool during follow up. Methods This is a prospective, observational study. Suspected GCA Participants will be selected from the GCA FTC at the participating centres in the UK. Informed consent will be obtained, and patients managed as part of standard care. Patients with GCA will have HS (temporal and axillary arteries) measured at baseline and months 1,3,6 and 12 long with routine clinical assessments, blood sampling and patient-reported outcomes (EQ5D). Non-GCA patients will be discharged back to the referral team and will have a telephone interview in 6 months. We aim to recruit 272 suspected GCA referrals which should yield 68 patients (25% of referrals) with confirmed GCA. The recruitment will be completed in 1 year with an estimated total study period of 24 months. Discussion The identification of prognostic factors in GCA is both timely and needed. A prognostic marker, such as the HS, could help to stratify GCA patients for an appropriate treatment regimen. Tocilizumab, an IL-6R blocking agent, switches off the acute phase response (C-Reactive Protein), making it difficult to measure the disease activity. Therefore, an independent HS, and changes in that score during treatment and follow-up, maybe a more objective measure of response compare to patient-reported symptoms and clinical assessment alone. |
| first_indexed | 2024-12-11T15:46:33Z |
| format | Article |
| id | doaj.art-364b3073c3cd4f30936e16f893ea2b13 |
| institution | Directory Open Access Journal |
| issn | 2520-1026 |
| language | English |
| last_indexed | 2024-12-11T15:46:33Z |
| publishDate | 2020-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Rheumatology |
| spelling | doaj.art-364b3073c3cd4f30936e16f893ea2b132022-12-22T00:59:41ZengBMCBMC Rheumatology2520-10262020-08-014111010.1186/s41927-020-00136-5Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA)Alwin Sebastian0Kornelis S. M. van der Geest1Fiona Coath2Prisca Gondo3Abdul Kayani4Craig Mackerness5Bernard Hadebe6Sue Innes7Jo Jackson8Bhaskar Dasgupta9Rheumatology, Mid and South Essex University Hospital Groups, Southend University HospitalRheumatology and Clinical Immunology, University Medical Center Groningen, University of GroningenNorfolk and Norwich University hospitals NHS Foundation TrustR&D, Mid and South Essex University Hospital Groups, Southend University HospitalRheumatology, Mid and South Essex University Hospital Groups, Southend University HospitalR&D, Mid and South Essex University Hospital Groups, Southend University HospitalR&D, Mid and South Essex University Hospital Groups, Southend University HospitalSchool of Sport, Rehabilitation and exercise sciences, Colchester campus, University of EssexSchool of Sport, Rehabilitation and exercise sciences, Colchester campus, University of EssexRheumatology, Mid and South Essex University Hospital Groups, Southend University HospitalAbstract Background Giant cell arteritis (GCA) is a common large vessel vasculitis of the elderly, often associated with sight loss. Glucocorticoids (GC remain the mainstay of treatment, although biologic treatments have been approved. Biomarkers predicting disease severity, relapse rates and damage are lacking in GCA. EULAR recommends ultrasound (US) as the first investigation for suspected GCA. The cardinal US finding, a non-compressible halo, is currently categorised as either negative or positive. However, the extent and severity of this finding may vary. In this study, we hypothesise whether the extent and severity of the halo sign [calculated as a single composite Halo score (HS)] of temporal and axillary arteries may be of diagnostic, prognostic and monitoring importance; whether baseline HS is linked to disease outcomes, relapses and damage; whether HS can stratify GCA patients for individual treatment needs; whether HS can function as an objective monitoring tool during follow up. Methods This is a prospective, observational study. Suspected GCA Participants will be selected from the GCA FTC at the participating centres in the UK. Informed consent will be obtained, and patients managed as part of standard care. Patients with GCA will have HS (temporal and axillary arteries) measured at baseline and months 1,3,6 and 12 long with routine clinical assessments, blood sampling and patient-reported outcomes (EQ5D). Non-GCA patients will be discharged back to the referral team and will have a telephone interview in 6 months. We aim to recruit 272 suspected GCA referrals which should yield 68 patients (25% of referrals) with confirmed GCA. The recruitment will be completed in 1 year with an estimated total study period of 24 months. Discussion The identification of prognostic factors in GCA is both timely and needed. A prognostic marker, such as the HS, could help to stratify GCA patients for an appropriate treatment regimen. Tocilizumab, an IL-6R blocking agent, switches off the acute phase response (C-Reactive Protein), making it difficult to measure the disease activity. Therefore, an independent HS, and changes in that score during treatment and follow-up, maybe a more objective measure of response compare to patient-reported symptoms and clinical assessment alone.http://link.springer.com/article/10.1186/s41927-020-00136-5Outcomes in GCARisk stratificationPrognostic factorsHalo scoreGCA probability scoreClinical severity index |
| spellingShingle | Alwin Sebastian Kornelis S. M. van der Geest Fiona Coath Prisca Gondo Abdul Kayani Craig Mackerness Bernard Hadebe Sue Innes Jo Jackson Bhaskar Dasgupta Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA) BMC Rheumatology Outcomes in GCA Risk stratification Prognostic factors Halo score GCA probability score Clinical severity index |
| title | Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA) |
| title_full | Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA) |
| title_fullStr | Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA) |
| title_full_unstemmed | Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA) |
| title_short | Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA) |
| title_sort | halo score temporal artery its branches and axillary artery as a diagnostic prognostic and disease monitoring tool for giant cell arteritis gca |
| topic | Outcomes in GCA Risk stratification Prognostic factors Halo score GCA probability score Clinical severity index |
| url | http://link.springer.com/article/10.1186/s41927-020-00136-5 |
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