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van der Geest KSM, Wolfe K, Borg F, Sebastian A, Kayani A, Tomelleri A, Gondo P, Schmidt WA, Luqmani R, Dasgupta B. Ultrasonographic Halo Score in giant cell arteritis: association with intimal hyperplasia and ischaemic sight loss. Rheumatology (Oxford) 2020; 60:4361-4366. [PMID: 33355340 PMCID: PMC8410002 DOI: 10.1093/rheumatology/keaa806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives We investigated the relationship between the ultrasonographic Halo Score and temporal artery biopsy (TAB) findings in GCA. Methods This is a prospective study including 90 patients suspected of having GCA. Ultrasonography of temporal/axillary arteries and a TAB were obtained in all patients at baseline. An experienced pathologist evaluated whether TAB findings were consistent with GCA, and whether transmural inflammation, giant cells and intimal hyperplasia were present. Ultrasonographic Halo Scores were determined. Receiver operating characteristic analysis was performed. Results Twenty-seven patients had a positive TAB, while 32 patients with a negative TAB received a clinical diagnosis of GCA after 6 months of follow-up. Patients with a positive TAB showed higher Halo Scores than patients with a negative TAB. The presence of intimal hyperplasia in the biopsy, rather than the presence of transmural inflammation or giant cells, was associated with elevated Halo Scores in patients with GCA. The Halo Score discriminated well between TAB-positive patients with and without intimal hyperplasia, as indicated by an area under the curve of 0.82 in the receiver operating characteristic analysis. Patients with a positive TAB and intimal hyperplasia more frequently presented with ocular ischaemia (40%) than the other patients with GCA (13–14%). Conclusion The ultrasonographic Halo Score may help to identify a subset of GCA patients with intimal hyperplasia, a TAB feature associated with ischaemic sight loss.
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Affiliation(s)
- Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Rheumatology
| | - Konrad Wolfe
- Department of Pathology, Southend University Hospital, Westcliff-on-sea,UK
| | | | | | | | | | | | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Raashid Luqmani
- Department of Rheumatology, NDORMS, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
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Sebastian A, van der Geest KSM, Coath F, Gondo P, Kayani A, Mackerness C, Hadebe B, Innes S, Jackson J, Dasgupta B. Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA). BMC Rheumatol 2020; 4:35. [PMID: 32821876 PMCID: PMC7433165 DOI: 10.1186/s41927-020-00136-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/03/2020] [Indexed: 12/15/2022] Open
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.
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Affiliation(s)
- Alwin Sebastian
- Rheumatology, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
- University of Essex, Colchester, UK
| | - Kornelis S M van der Geest
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fiona Coath
- Norfolk and Norwich University hospitals NHS Foundation Trust, Colney Ln, Norwich, UK
| | - Prisca Gondo
- R&D, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
| | - Abdul Kayani
- Rheumatology, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
| | - Craig Mackerness
- R&D, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
| | - Bernard Hadebe
- R&D, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
| | - Sue Innes
- School of Sport, Rehabilitation and exercise sciences, Colchester campus, University of Essex, Colchester, UK
| | - Jo Jackson
- School of Sport, Rehabilitation and exercise sciences, Colchester campus, University of Essex, Colchester, UK
| | - Bhaskar Dasgupta
- Rheumatology, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
- University of Essex, Colchester, UK
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van der Geest KS, Borg F, Kayani A, Paap D, Gondo P, Schmidt W, Luqmani RA, Dasgupta B. Response to: 'Diagnostic accuracy of novel ultrasonographic halo score for giant cell arteritis: methodological issues' by Ghajari and Sabour. Ann Rheum Dis 2020; 81:e106. [PMID: 32571871 DOI: 10.1136/annrheumdis-2020-218144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Kornelis Sm van der Geest
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Frances Borg
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Abdul Kayani
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Davy Paap
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Prisca Gondo
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Wolfgang Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel-Krankenhaus GmbH, Berlin, Berlin, Germany
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Bhaskar Dasgupta
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
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van der Geest KSM, Borg F, Kayani A, Paap D, Gondo P, Schmidt W, Luqmani RA, Dasgupta B. Novel ultrasonographic Halo Score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia. Ann Rheum Dis 2020; 79:393-399. [PMID: 31900304 PMCID: PMC7034352 DOI: 10.1136/annrheumdis-2019-216343] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/18/2019] [Accepted: 12/16/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Ultrasound of temporal and axillary arteries may reveal vessel wall inflammation in patients with giant cell arteritis (GCA). We developed a ultrasound scoring system to quantify the extent of vascular inflammation and investigated its diagnostic accuracy and association with clinical factors in GCA. METHODS This is a prospective study including 89 patients suspected of having GCA, of whom 58 had a confirmed clinical diagnosis of GCA after 6 months follow-up. All patients underwent bilateral ultrasound examination of the three temporal artery (TA) segments and axillary arteries, prior to TA biopsy. The extent of vascular inflammation was quantified by (1) counting the number of TA segments and axillary arteries with a halo and (2) calculating a composite Halo Score that also incorporated the thickness of each halo. RESULTS Halo counts and Halo Scores showed moderate diagnostic accuracy for a clinical diagnosis of GCA. They correlated positively with systemic inflammation. When compared with the halo count, the Halo Score correlated better with C-reactive protein (CRP) levels and allowed to firmly establish the diagnosis of GCA in more patients. Higher halo counts and Halo Scores were associated with a higher risk of ocular ischaemia. They allowed to identify subgroups of patients with low risk (≤5%) and high risk of ocular ischaemia (>30%). CONCLUSIONS Ultrasound halo scoring allows to quantify the extent of vascular inflammation in GCA. Extensive vascular inflammation on ultrasound may provide strong diagnostic confirmation and associates with ocular ischaemia in GCA.
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Affiliation(s)
- Kornelis S M van der Geest
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Frances Borg
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Abdul Kayani
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Davy Paap
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Prisca Gondo
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Wolfgang Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel-Krankenhaus GmbH, Berlin, Germany
| | - Raashid Ahmed Luqmani
- Rheumatology, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, Oxfordshire, UK
| | - Bhaskar Dasgupta
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
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Carmona FD, Vaglio A, Mackie SL, Hernández-Rodríguez J, Monach PA, Castañeda S, Solans R, Morado IC, Narváez J, Ramentol-Sintas M, Pease CT, Dasgupta B, Watts R, Khalidi N, Langford CA, Ytterberg S, Boiardi L, Beretta L, Govoni M, Emmi G, Bonatti F, Cimmino MA, Witte T, Neumann T, Holle J, Schönau V, Sailler L, Papo T, Haroche J, Mahr A, Mouthon L, Molberg Ø, Diamantopoulos AP, Voskuyl A, Brouwer E, Daikeler T, Berger CT, Molloy ES, O’Neill L, Blockmans D, Lie BA, Mclaren P, Vyse TJ, Wijmenga C, Allanore Y, Koeleman BP, Barrett JH, Cid MC, Salvarani C, Merkel PA, Morgan AW, González-Gay MA, Martín J, Callejas JL, Caminal-Montero L, Corbera-Bellalta M, de Miguel E, López JBD, García-Villanueva MJ, Gómez-Vaquero C, Guijarro-Rojas M, Hidalgo-Conde A, Marí-Alfonso B, Berriochoa AM, Zapico AM, Martínez-Taboada VM, Miranda-Filloy JA, Monfort J, Ortego-Centeno N, Pérez-Conesa M, Prieto-González S, Raya E, Fernández RR, Sánchez-Martín J, Sopeña B, Tío L, Unzurrunzaga A, Gough A, Isaacs JD, Green M, McHugh N, Hordon L, Kamath S, Nisar M, Patel Y, Yee CS, Stevens R, Nandi P, Nandagudi A, Jarrett S, Li C, Levy S, Mollan S, Salih A, Wordsworth O, Sanders E, Roads E, Gill A, Carr L, Routledge C, Culfear K, Nugaliyadde A, James L, Spimpolo J, Kempa A, Mackenzie F, Fong R, Peters G, Rowbotham B, Masqood Z, Hollywood J, Gondo P, Wood R, Martin S, Rashid LH, Robinson JI, Morgan M, Sorensen L, Taylor J, Carette S, Chung S, Cuthbertson D, Forbess LJ, Gewurz-Singer O, Hoffman GS, Koening CL, Maksimowicz-McKinnon KM, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Spiera RF, Sreih A, Warrington KJ, Weisman M. A Genome-wide Association Study Identifies Risk Alleles in Plasminogen and P4HA2 Associated with Giant Cell Arteritis. Am J Hum Genet 2017; 100:64-74. [PMID: 28041642 DOI: 10.1016/j.ajhg.2016.11.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023] Open
Abstract
Giant cell arteritis (GCA) is the most common form of vasculitis in individuals older than 50 years in Western countries. To shed light onto the genetic background influencing susceptibility for GCA, we performed a genome-wide association screening in a well-powered study cohort. After imputation, 1,844,133 genetic variants were analyzed in 2,134 case subjects and 9,125 unaffected individuals from ten independent populations of European ancestry. Our data confirmed HLA class II as the strongest associated region (independent signals: rs9268905, p = 1.94 × 10-54, per-allele OR = 1.79; and rs9275592, p = 1.14 × 10-40, OR = 2.08). Additionally, PLG and P4HA2 were identified as GCA risk genes at the genome-wide level of significance (rs4252134, p = 1.23 × 10-10, OR = 1.28; and rs128738, p = 4.60 × 10-9, OR = 1.32, respectively). Interestingly, we observed that the association peaks overlapped with different regulatory elements related to cell types and tissues involved in the pathophysiology of GCA. PLG and P4HA2 are involved in vascular remodelling and angiogenesis, suggesting a high relevance of these processes for the pathogenic mechanisms underlying this type of vasculitis.
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Chandiwana SK, Taylor P, Chimbari M, Ndhlovu P, Makura O, Bradley M, Gondo P. Control of schistosomiasis transmission in newly established smallholder irrigation schemes. Trans R Soc Trop Med Hyg 1988; 82:874-80. [PMID: 3151528 DOI: 10.1016/0035-9203(88)90024-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The extent to which schistosomiasis can be controlled through careful design of the irrigation works, the operation schedule, the location of villages and the provision of safe water supplies and sanitation in smallholder irrigation schemes at Mushandike in south-east Zimbabwe is reported. The schemes provide land for 400 peasant families who are monitored for schistosomiasis soon after resettlement. Between April 1986 and August 1987 there was a marked reduction in overall prevalence following treatment. For Schistosoma haematobium, the reductions in 2 schemes were 53% and 82% and for S. mansoni, 82% and 100%, in spite of transmission in settlements upstream from the schemes. In contrast, in a nearby irrigated farm where no control measures were introduced, S. haematobium prevalence declined by only 31% while that for S. mansoni increased by 22% a year following treatment. These results are supported and strengthened by measurements of snail population sizes and their infection rates, cercarial densities in the water and incidence data for the human population, and suggest that the engineering and environmental control measures introduced are significant means of controlling transmission in smallholder irrigation schemes with the lowest recurrent costs.
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