COLOR DOPPLER ULTRASONOGRAPHY IN THE DIAGNOSIS AND MANAGEMENT OF GIANT CELL ARTERITIS.

Giant cell arteritis (GCA) is a chronic granulomatous vasculitis affecting large- and medium-size arteries, in particular, main branches of the ascending aorta [1]. The spectrum of clinical manifestations includes a various S110 Proof for internal use only – copyright protected symptoms such as a severe headache, scalp tenderness, jaw claudication, tender and swollen temporal arteries, ischemic symptoms (stroke, TIA, arm claudication), polymyalgia rheumatica and systemic symptoms including lowgrade fever, fatigue and weight loss. Irreversible visual loss secondary to ischemic optic neuropathy is a serious complication of non-treatment, so prompt diagnosis and treatment are mandatory to prevent it [1]. However, typical clinical findings and elevation of acute phase reactants are insufficient to give diagnostic certainty, and the American College of Rheumatology (ACR) classification criteria [2] have significant limitations in clinical diagnosis [3]. Temporal artery (TA) biopsy is thus considered the gold standard because of its high specificity [1], but it can be negative in up to 10–44% of patients [4]. The usefulness of colour Doppler (CD) and Colour Duplex ultrasound (CDUS) in the diagnosis of GCA was first demonstrated in 1995 by Schmidt and colleagues [5] and since then it has been emphasized in many studies [6]. In particular, the presence of the ‘‘halo sign’’ (a dark area around the vessel lumen) is strongly related to the acute phase of the disease and appears highly specific for GCA. The absence of a halo sign however does not fully rule out GCA. The aim of our study was to evaluate the role of CD ultrasonography in diagnosing, monitoring and tapering glucocorticoid therapy in patients with GCA.