EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice

Published on May 1, 2018in Annals of the Rheumatic Diseases14.299
· DOI :10.1136/annrheumdis-2017-212649
Christian Dejaco27
Estimated H-index: 27
Sofia Ramiro27
Estimated H-index: 27
(LUMC: Leiden University Medical Center)
+ 17 AuthorsWolfgang A. Schmidt32
Estimated H-index: 32
To develop evidence-based recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV) including giant cell arteritis (GCA) and Takayasu arteritis (TAK). European League Against Rheumatism (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound, MRI, CT and [18F]-fluorodeoxyglucose positron emission tomography (PET) in LVV. Based on evidence and expert opinion, the task force consisting of 20 physicians, healthcare professionals and patients from 10 EULAR countries developed recommendations, with consensus obtained through voting. The final level of agreement was voted anonymously. A total of 12 recommendations have been formulated. The task force recommends an early imaging test in patients with suspected LVV, with ultrasound and MRI being the first choices in GCA and TAK, respectively. CT or PET may be used alternatively. In case the diagnosis is still in question after clinical examination and imaging, additional investigations including temporal artery biopsy and/or additional imaging are required. In patients with a suspected flare, imaging might help to better assess disease activity. The frequency and choice of imaging modalities for long-term monitoring of structural damage remains an individual decision; close monitoring for aortic aneurysms should be conducted in patients at risk for this complication. All imaging should be performed by a trained specialist using appropriate operational procedures and settings. These are the first EULAR recommendations providing up-to-date guidance for the role of imaging in the diagnosis and monitoring of patients with (suspected) LVV.
  • References (55)
  • Citations (114)
📖 Papers frequently viewed together
207 Citations
1,528 Citations
88 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Stavros ChrysidisH-Index: 7
#2Christina Duftner (Innsbruck Medical University)H-Index: 24
Last. Wolfgang A. SchmidtH-Index: 32
view all 30 authors...
Objectives To define the elementary ultrasound (US) lesions in giant cell arteritis (GCA) and to evaluate the reliability of the assessment of US lesions according to these definitions in a web-based reliability exercise. Methods Potential definitions of normal and abnormal US findings of temporal and extracranial large arteries were retrieved by a systematic literature review. As a subsequent step, a structured Delphi exercise was conducted involving an expert panel of the Outcome Measures in R...
17 CitationsSource
#1Sara Monti (UNIPV: University of Pavia)H-Index: 9
#2Alberto FlorisH-Index: 8
Last. Raashid Luqmani (NOC: Nuffield Orthopaedic Centre)H-Index: 53
view all 8 authors...
24 CitationsSource
#1Aytac Gulcu (Dokuz Eylül University)H-Index: 12
#2Naciye Sinem Gezer (Dokuz Eylül University)H-Index: 6
Last. Ahmet Yigit Goktay (Dokuz Eylül University)H-Index: 5
view all 6 authors...
Background This retrospective study evaluated the long-term results of endovascular repair in the management of arterial stenosis caused by Takayasu's arteritis (TA). Methods Sixty-seven endovascular procedures (percutaneous transluminal balloon angioplasty or stenting) were performed for 49 arterial lesions in 35 patients. Endovascular treatment was performed when the disease was inactive. The patients were pretreated with immunosuppressive drugs and were followed every 3–6 months to monitor di...
5 CitationsSource
Abstract Takayasu's arteritis (TAK) is a rare, chronic, large-vessel vasculitis (LVV) that predominantly affects aorta, its major branches and the pulmonary arteries. Recent controversial issues in the diagnosis, disease assessment and prognosis in TAK are discussed in this review. In recent years, conventional angiography, the standard method for the initial diagnosis, seems to have been replaced by the new imaging modalities, such as MRI and 18F-FDG-PET. Less invasive techniques (CT/MRI) are n...
11 Citations
#1Raashid Luqmani (University of Oxford)H-Index: 53
#2Ellen Lee (University of Sheffield)H-Index: 11
Last. Andrew Hutchings (Lond: University of London)H-Index: 31
view all 19 authors...
88 CitationsSource
#1Christian Dejaco (University of Graz)H-Index: 27
#2Christina DuftnerH-Index: 24
Last. Bhaskar DasguptaH-Index: 35
view all 5 authors...
46 CitationsSource
#1D. LarivièreH-Index: 3
#2Khadija BenaliH-Index: 8
Last. Karim SacreH-Index: 20
view all 13 authors...
AbstractThe use of 18F-fluoro-deoxyglucose positron emission tomography scan (FDG-PET) and computed tomography angiography (CTA) to improve accuracy of diagnosis of giant cell arteritis (GCA) is a very important clinical need. We aimed to compare the diagnostic performance of FDG-PET and CTA in pati
34 CitationsSource
#1Andreas P. Diamantopoulos (Hospital of Southern Norway)H-Index: 17
#2Glenn Haugeberg (NTNU: Norwegian University of Science and Technology)H-Index: 33
Last. G. Myklebust (Hospital of Southern Norway)H-Index: 7
view all 4 authors...
Permanent visual impairment has been reported to occur in up to 19% of GCA patients. The aim of this study was to examine whether implementation of a fast-track approach could reduce the rate of permanent visual impairment and inpatient days of care in GCA patients.A fast-track outpatient GCA clinic (FTC) was implemented in the Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Norway in 2012. The patients included in this study were subsequently recruited between March ...
48 CitationsSource
#1Giuseppe Germanò (UNIME: University of Messina)H-Index: 7
#2Francesco Muratore (UNIME: University of Messina)H-Index: 14
Last. Carlo Salvarani (UNIME: University of Messina)H-Index: 70
view all 10 authors...
32 CitationsSource
#1Francesco Muratore (UCLA: University of California, Los Angeles)H-Index: 14
#2Tanaz A. Kermani (UCLA: University of California, Los Angeles)H-Index: 18
Last. Kenneth J. Warrington (University of California, Berkeley)H-Index: 33
view all 7 authors...
Objective. The aim of this study was to compare baseline variables, treatment and outcomes in patients with large-vessel GCA (LV-GCA), primarily of the upper extremities, with those with cranial disease (C-GCA). Methods. All patients >50 years of age with radiographic evidence of subclavian LV-GCA diagnosed between 1 January 1999 and 31 December 2008 were identified and compared with those with biopsy-positive C-GCA diagnosed in the same period. Results. The study included 120 LV-GCA patients an...
102 CitationsSource
Cited By114
#1Matthew J. Samec (Mayo Clinic)
#2Andres G. Madrigal (Mayo Clinic)
Last. Matthew J. Koster (Mayo Clinic)H-Index: 6
view all 4 authors...
BACKGROUND: Given the absence of consensus diagnostic criteria for giant cell arteritis, clinicians may encounter difficulty with identification of new-onset headache in patients older than age 50 years presenting with visual changes and elevated inflammatory markers, particularly if temporal artery biopsies are performed and negative. CASE PRESENTATION: We present a case of a 57-year-old white man with headache, diplopia, and jaw paresthesia initially diagnosed and managed as steroid-refractory...
#1C Ponte (IMM: Instituto de Medicina Molecular)H-Index: 4
#2Nikita Khmelinskii (IMM: Instituto de Medicina Molecular)H-Index: 2
view all 34 authors...
BACKGROUND: The vasculitides are a group of rare diseases with different manifestations and outcomes. New therapeutic options have led to the need for long-term registries. The Rheumatic Diseases Portuguese Register,, is a web-based electronic clinical record, created in 2008, which currently includes specific modules for 12 diseases and > 20,000 patients registered from 79 rheumatology centres. On October 2014, a dedicated module for vasculitis was created as part of the European Vascu...
#1C Ponte (IMM: Instituto de Medicina Molecular)H-Index: 4
Last. Raashid Luqmani (University of Oxford)H-Index: 53
view all 3 authors...
GCA is the most common form of primary systemic vasculitis affecting older people. It is considered a clinical emergency because it can lead to irreversible blindness in around 20% of untreated cases. High doses of glucocorticoids should be initiated promptly to prevent disease-related complications; however, glucocorticoids therapy usually results in significant toxicity. Therefore, correct diagnosis is crucial. For many years, temporal artery biopsy has been considered the diagnostic 'gold sta...
Giant cell arteritis (GCA) may affect the brain-supplying arteries, resulting in ischemic stroke, whereby the vertebrobasilar territory is most often involved. Since etiology is unknown in 25% of stroke patients and GCA is hardly considered as a cause, we examined in a pilot study, whether screening for GCA after vertebrobasilar stroke might unmask an otherwise missed disease. Consecutive patients with vertebrobasilar stroke were prospectively screened for GCA using erythrocyte sedimentation rat...
#1Takahiko Sugihara (Tokyo Medical and Dental University)H-Index: 13
#2Hitoshi Hasegawa (Ehime University)H-Index: 34
Last. Noriyoshi Ogawa (Hamamatsu University)H-Index: 13
view all 21 authors...
BACKGROUND: Relapses frequently occur in giant cell arteritis (GCA), and long-term glucocorticoid therapy is required. The identification of associated factors with poor treatment outcomes is important to decide the treatment algorithm of GCA. METHODS: We enrolled 139 newly diagnosed GCA patients treated with glucocorticoids between 2007 and 2014 in a retrospective, multi-center registry. Patients were diagnosed with temporal artery biopsy, 1990 American College of Rheumatology classification cr...
#1H. HopH-Index: 1
#2Douwe J. MulderH-Index: 13
Last. Elisabeth BrouwerH-Index: 36
view all 7 authors...
OBJECTIVES: To compare colour duplex ultrasonography (CDU) findings with axillary 18F-fluorodeoxyglucose (FDG) PET/CT findings and to compare the diagnostic performance of temporal and axillary artery CDU with temporal artery CDU alone. METHODS: Patients suspected of GCA were retrospectively included. Presence of a halo or occlusion was considered a positive CDU finding. FDG-PET/CT-assessed axillary artery involvement was defined as axillary artery FDG uptake higher than liver uptake. The refere...
Objectives To compare the diagnostic accuracy of 3D versus 2D contrast-enhanced vessel-wall (CE-VW) MRI of extracranial and intracranial arteries in the diagnosis of GCA.
#1Francesca ValentH-Index: 26
#2Milena Bond (University of Udine)H-Index: 3
Last. Luca Quartuccio (University of Udine)H-Index: 27
view all 9 authors...
Giant cell arteritis (GCA) is the most common vasculitis in adults. However, comprehensive analyses of the healthcare burden are still scarce. The aim of the study is to report the healthcare burde...
#1Mattia BellanH-Index: 8
#2Erinda PutaH-Index: 3
Last. Pier Paolo SainaghiH-Index: 13
view all 14 authors...
Giant cell arteritis (GCA) is characterized by two subsets: cranial GCA and large-vessel GCA (LV-GCA); positron emission tomography (PET) is an essential tool in the diagnosis of LV-GCA. In this study, we aimed to investigate its potential prognostic value in the stratification of relapse risk. We retrospectively revised all the clinical records of patients who received a diagnosis of GCA at an immuno-rheumatology clinic of a University Hospital along 6 years and who underwent to a PET-CT examin...
A 74-year-old woman presented with a 6-month history of malaise, generalized fatigue, significant unintentional weight loss, and night sweats, as well as pain, weakness, and stiffness in the shoulder girdle most severe in the morning. She reported no headache, visual disturbances, or jaw