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Subclavian artery involvement in patients with giant cell arteritis: do we need a modified Halo Score?

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Abstract

Objective

To assess whether adding the subclavian artery examination into the ultrasound (US) Southend Halo Score, as proposed in the modified Halo Score, improves the diagnostic accuracy of giant cell arteritis (GCA) and its relationship with systemic inflammation.

Methods

Retrospective observational study of patients referred to a GCA fast track pathway (FTP) over a 1-year period. Patients underwent US exam of temporal and large vessel (LV) (carotid, subclavian, and axillary) arteries. The extent of inflammation was measured by the halo count, the Southend Halo Score, and the modified Halo Score. The gold standard for GCA diagnosis was clinical confirmation after 6-month follow-up.

Results

Sixty-four patients were evaluated in the FTP, 17 (26.5%) had GCA. Subclavian artery involvement was present only in patients with GCA (29.4% versus 0%, p < 0.001). Overall, the three scores showed excellent diagnostic accuracy for GCA (ROC AUC 0.906, 0.930, and 0.928, respectively) and moderate correlations with acute phase reactants (0.35–0.51, p < 0.01). Only the modified Halo Score correlated with markers of inflammation in patients with LV involvement.

Conclusions

The inclusion of subclavian artery examination in the modified Halo Score does not improve the diagnostic accuracy of GCA. Nevertheless, it correlates better with markers of systemic inflammation in LV-GCA.

Key Points

• Adding the subclavian artery examination into the Southend Halo Score, as proposed in the modified Halo Score, does not improve the diagnostic accuracy of GCA.

• However, the extent of vascular inflammation as quantified by the modified Halo Score correlates better with markers of systemic inflammation in the large vessel (LV) GCA subgroup of patients.

• Although the diagnostic value of adding subclavian arteries to the current recommended US examination of GCA is limited, it may have a role in monitoring disease activity as it correlates with the general burden of inflammation in LV GCA. These findings need to be confirmed in additional populations and larger prospective studies.

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Acknowledgments

The authors thank all the patients who participated in this study.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain

    Juan Molina Collada, Julia Martínez-Barrio, Belén Serrano-Benavente, Isabel Castrejón, Juan Carlos Nieto-González, Liz Rocío Caballero Motta, Laura Trives Folguera & José María Álvaro-Gracia

  2. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain

    Juan Molina Collada, Julia Martínez-Barrio, Belén Serrano-Benavente, Isabel Castrejón, Juan Carlos Nieto-González, Liz Rocío Caballero Motta, Laura Trives Folguera & José María Álvaro-Gracia

Authors
  1. Juan Molina Collada
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  2. Julia Martínez-Barrio
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  3. Belén Serrano-Benavente
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  4. Isabel Castrejón
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  5. Juan Carlos Nieto-González
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  6. Liz Rocío Caballero Motta
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  7. Laura Trives Folguera
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  8. José María Álvaro-Gracia
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Contributions

All authors made substantial contributions to the conception and design of this study. Study design, subject recruitment, and US examination were performed by JMC. JMC and LCM collected the epidemiological and clinical data. JMC and IC performed the statistical analysis. JMC, JMB, BSB, IC, JCN-G, LCM, LTF, and JAG drafted the manuscript. All co-authors revised the final manuscript.

Corresponding author

Correspondence to Juan Molina Collada.

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Patients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research

Ethics approval

The research protocol has been approved by the Research ethical Committee of Hospital General Universitario Gregorio Marañón, and all patients gave informed written consent for their participation in the study.

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Molina Collada, J., Martínez-Barrio, J., Serrano-Benavente, B. et al. Subclavian artery involvement in patients with giant cell arteritis: do we need a modified Halo Score?. Clin Rheumatol 40, 2821–2827 (2021). https://doi.org/10.1007/s10067-020-05577-4

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  • DOI: https://doi.org/10.1007/s10067-020-05577-4

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