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Vascular Ultrasound for Giant Cell Arteritis: Establishing a Protocol Using Vascular Sonographers in a Fast‐Track Clinic in the United States
OBJECTIVE: We developed a fast‐track clinic (FTC) to expedite the evaluation of patients suspected of having giant cell arteritis (GCA) using vascular ultrasound. Though FTCs have demonstrated efficacy in Europe, no protocolized clinic in the United States has been developed. This study introduces a...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754016/ https://www.ncbi.nlm.nih.gov/pubmed/34647696 http://dx.doi.org/10.1002/acr2.11346 |
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author | Oshinsky, Charles Bays, Alison M. Sacksen, Ingeborg Jernberg, Elizabeth Zierler, R. Eugene Diamantopoulos, Andreas P. Liew, Jean W. Chung, Sarah H. Pollock, P. Scott |
author_facet | Oshinsky, Charles Bays, Alison M. Sacksen, Ingeborg Jernberg, Elizabeth Zierler, R. Eugene Diamantopoulos, Andreas P. Liew, Jean W. Chung, Sarah H. Pollock, P. Scott |
author_sort | Oshinsky, Charles |
collection | PubMed |
description | OBJECTIVE: We developed a fast‐track clinic (FTC) to expedite the evaluation of patients suspected of having giant cell arteritis (GCA) using vascular ultrasound. Though FTCs have demonstrated efficacy in Europe, no protocolized clinic in the United States has been developed. This study introduces a new FTC model unique to the United States, using vascular sonographers, and describes the protocols used to develop reliable findings. We evaluate clinical outcomes using vascular ultrasound and temporal artery biopsy (TAB). METHODS: A retrospective review included all subjects referred to the University of Washington FTC aged 50 years old or older who received both ultrasound and TAB between November 2017 and November 2019. Ultrasound was performed by a vascular sonographer trained in GCA detection. Ultrasound results were read by a vascular surgeon and reviewed by four rheumatologists certified in musculoskeletal ultrasound who had completed a course in vascular ultrasound use in GCA and large‐vessel vasculitis. RESULTS: A total of 43 subjects underwent both vascular ultrasound and TAB. Six subjects had both positive ultrasound and TAB results. There were also seven positive ultrasound results in patients with negative TAB results, most due to detection of large‐vessel GCA (LV‐GCA). All 29 subjects with negative ultrasound results had negative TAB results. CONCLUSION: This is the first study in the United States to demonstrate a reliable FTC protocol using vascular sonographers. This protocol demonstrated good agreement between ultrasound and TAB and allowed for the detection of additional cases of LV‐GCA by vascular ultrasound. Vascular ultrasound improved the rate of GCA diagnosis primarily by detecting additional cases of LV‐GCA. |
format | Online Article Text |
id | pubmed-8754016 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-87540162022-01-19 Vascular Ultrasound for Giant Cell Arteritis: Establishing a Protocol Using Vascular Sonographers in a Fast‐Track Clinic in the United States Oshinsky, Charles Bays, Alison M. Sacksen, Ingeborg Jernberg, Elizabeth Zierler, R. Eugene Diamantopoulos, Andreas P. Liew, Jean W. Chung, Sarah H. Pollock, P. Scott ACR Open Rheumatol Original Articles OBJECTIVE: We developed a fast‐track clinic (FTC) to expedite the evaluation of patients suspected of having giant cell arteritis (GCA) using vascular ultrasound. Though FTCs have demonstrated efficacy in Europe, no protocolized clinic in the United States has been developed. This study introduces a new FTC model unique to the United States, using vascular sonographers, and describes the protocols used to develop reliable findings. We evaluate clinical outcomes using vascular ultrasound and temporal artery biopsy (TAB). METHODS: A retrospective review included all subjects referred to the University of Washington FTC aged 50 years old or older who received both ultrasound and TAB between November 2017 and November 2019. Ultrasound was performed by a vascular sonographer trained in GCA detection. Ultrasound results were read by a vascular surgeon and reviewed by four rheumatologists certified in musculoskeletal ultrasound who had completed a course in vascular ultrasound use in GCA and large‐vessel vasculitis. RESULTS: A total of 43 subjects underwent both vascular ultrasound and TAB. Six subjects had both positive ultrasound and TAB results. There were also seven positive ultrasound results in patients with negative TAB results, most due to detection of large‐vessel GCA (LV‐GCA). All 29 subjects with negative ultrasound results had negative TAB results. CONCLUSION: This is the first study in the United States to demonstrate a reliable FTC protocol using vascular sonographers. This protocol demonstrated good agreement between ultrasound and TAB and allowed for the detection of additional cases of LV‐GCA by vascular ultrasound. Vascular ultrasound improved the rate of GCA diagnosis primarily by detecting additional cases of LV‐GCA. John Wiley and Sons Inc. 2021-10-14 /pmc/articles/PMC8754016/ /pubmed/34647696 http://dx.doi.org/10.1002/acr2.11346 Text en © 2021 The Authors. ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Articles Oshinsky, Charles Bays, Alison M. Sacksen, Ingeborg Jernberg, Elizabeth Zierler, R. Eugene Diamantopoulos, Andreas P. Liew, Jean W. Chung, Sarah H. Pollock, P. Scott Vascular Ultrasound for Giant Cell Arteritis: Establishing a Protocol Using Vascular Sonographers in a Fast‐Track Clinic in the United States |
title | Vascular Ultrasound for Giant Cell Arteritis: Establishing a Protocol Using Vascular Sonographers in a Fast‐Track Clinic in the United States |
title_full | Vascular Ultrasound for Giant Cell Arteritis: Establishing a Protocol Using Vascular Sonographers in a Fast‐Track Clinic in the United States |
title_fullStr | Vascular Ultrasound for Giant Cell Arteritis: Establishing a Protocol Using Vascular Sonographers in a Fast‐Track Clinic in the United States |
title_full_unstemmed | Vascular Ultrasound for Giant Cell Arteritis: Establishing a Protocol Using Vascular Sonographers in a Fast‐Track Clinic in the United States |
title_short | Vascular Ultrasound for Giant Cell Arteritis: Establishing a Protocol Using Vascular Sonographers in a Fast‐Track Clinic in the United States |
title_sort | vascular ultrasound for giant cell arteritis: establishing a protocol using vascular sonographers in a fast‐track clinic in the united states |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754016/ https://www.ncbi.nlm.nih.gov/pubmed/34647696 http://dx.doi.org/10.1002/acr2.11346 |
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