Giant cell arteritis (GCA) is a rare disease characterized by vasculitis of the large arterial trunks targeting the thoracic aorta and its dividing branches, affecting adults over the age of 50. Vasculitis lesions cause thickening of the arterial wall, visible on temporal artery biopsy (TAB) or vascular imaging (echo-Doppler, angio-CT, angio-MRI, 18FDG PET-CT). This is a severe disease that can lead to blindness. Early diagnosis is essential, so that steroids therapy can be started as soon as possible to prevent complications. Doppler ultrasonography of the temporal arteries provides rapid, non-invasive diagnostic support. However, the recommendations do not specify how soon temporal artery Doppler should be performed after steroids treatment, except that the halo sign would disappear after about 5 days on steroids. Sensitivity seems to be better when the examination is performed early, but the time taken for the halo sign to disappear is unknown. The investigator suggests that the disappearance of the temporal artery halo sign in GCA patients is observed earlier than D14 of steroids treatment usually reported in the literature. He speculates that the sensitivity of the temporal artery Doppler decreases as early as D3 of steroids treatment, and that beyond D7 it is not useful to perform this examination as its sensitivity becomes too low.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
64
Doppler ultrasound of temporal arteries at D0, D3 and D7 (+ D15 if halo detected at D7) after initiation of corticosteroid therapy.
Centre Hospitalier du Mans
Le Mans, Sarthe, France
CHU d'Angers
Angers, France
CHU Caen Normandie
Caen, France
CHU Dijon - Hôpital François Mitterrand
Dijon, France
Groupe hospitalier La Rochelle-Ré-Aunis
La Rochelle, France
CHU Nantes
Nantes, France
Number of patients with GCA AND temporal artery Doppler WITH a halo sign on Day 0 of corticosteroid therapy and disappearing on Day 3.
Time frame: From Day 0 to Day 3 of corticosteroid therapy
Assessment of vasculitis via Doppler on Day 3, Day 7, and Day 15
With Doppler ultrasound, the following signs of vasculitis will be assessed : Difficulty compressing the temporal artery, Temporal artery occlusion, Temporal artery stenosis, Bilateral or unilateral halo sign and Presence of halo sign on vascular axes other than temporal arteries. The absence or presence of these signs will be reported and used to evaluate the disappearance of the halo sign over time during corticosteroid therapy.
Time frame: On Day 3, Day 7 and Day 15 of corticosteroid therapy
Assessment of other vascular axes on Day 3
Number of patients with positive echo-Doppler signs of vasculitis in subclavian, axillary, common/external/internal carotid and vertebral arteries.
Time frame: On Day 3 of corticosteroid therapy
Assessment of the number of patients with disappearance of the halo sign on Day 7
Time frame: On Day 7 of corticosteroid therapy
Assessment of the number of patients with disappearance of the halo sign on Day 15
Time frame: On Day 15 of corticosteroid therapy
Correlation between histological arteritis and echo-doppler halo sign
Number of patients with positive histology on temporal artery biopsy (to be performed at investigator's discretion)
Time frame: On Day 0 of corticosteroid therapy
Correlation between C-reactive protein (CRP) kinetics and disappearance of the halo sign
Number of patients with positive C-reactive protein (CRP) on Day 3 and Day 7
Time frame: On Day 3 and Day 7 of corticosteroid therapy
Correlation between corticosteroid dose and disappearance of halo sign
* Number of patients receiving methylprednisolone bolus * Number of patients receiving prednisone equivalent greater than or equal to 60mg per day
Time frame: From Day 0 to Day 15
Number of patients on Tocilizumab with disappearance of Halo sign on Day 15
Time frame: On Day 15 of corticosteroid therapy
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