This website is intended for healthcare professionals only.

Newsletter      
Hospital Healthcare Europe
HOPE LOGO
Hospital Healthcare Europe

Share this article

Follow by Email
Facebook
Twitter

Combining symptoms, signs and laboratory tests best for diagnosing giant cell arteritis

Hospital Healthcare Europe
26 August, 2020  

Giant cell arteritis (GCA) is described as a ‘do not miss’ diagnosis in that any delays can lead to loss of vision.

According to a new systematic review, researchers from the Department of Rheumatology and Clinical Immunology, University of Groningen, found that a combination of clinical laboratory markers provides the most accurate way of diagnosing GCA.

They identified a total of 68 studies including 14,037 patients and calculated positive likelihood ratios (PLRs), that is, higher values indicate a higher probability that a factor increasing the risk of a disease, for a range of clinical symptoms and laboratory markers.

The results showed that significant clinical symptoms which, if present, should upgrade the level of suspicion for GCA were limb (PLR = 6.01) and jaw (PLR = 4.90) claudication, temporal artery thickening (PLR = 4.70) and temporal artery loss of pulse (PLR = 3.25). Significant laboratory markers included a platelet count of greater than 400 x 103/micro/litre (PLR = 3.75), erythrocyte sedimentation rates (ESR) of greater than 100mm/h (PLR = 3.11). In contrast, significant negative likelihood ratios included patients aged less than 70 years (LR = 0.48) and the absence of a C-reactive protein level of 2.5mg/dl or more (LR = 0.38).

The authors concluded that their study had identified the key clinical and laboratory markers which should be assessed when there was a suspicion of GCA.

Reference
Van der Geest KSM et al. Diagnostic accuracy of symptoms, physical signs, and laboratory tests for giant cell arteritis: A systematic review and meta-analysis. JAMA Intern Med 2020; August 17, 2020. doi:10.1001/jamainternmed.2020.3050