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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Timeframe for Halo sign resolution on Doppler ultrasound | Experimental | Doppler ultrasound of temporal arteries at D0, D3 and D7 (+/- D15) after initiation of corticosteroid therapy. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Doppler Ultrasound | Procedure | Doppler ultrasound of temporal arteries at D0, D3 and D7 (+ D15 if halo detected at D7) after initiation of corticosteroid therapy. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of patients with GCA AND temporal artery Doppler WITH a halo sign on Day 0 of corticosteroid therapy and disappearing on Day 3. | From Day 0 to Day 3 of corticosteroid therapy |
| Measure | Description | Time Frame |
|---|---|---|
| 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. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Christelle JADEAU, MD, PhD | Contact | +332 44 71 07 81 | cjadeau@ch-lemans.fr | |
| Pierre LOZAC'H, MD | Contact | +332 43 43 29 12 | plozach@ch-lemans.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centre Hospitalier du Mans | Le Mans | Sarthe | 72000 | France |
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| ID | Term |
|---|---|
| D013700 | Giant Cell Arteritis |
| ID | Term |
|---|---|
| D020293 | Vasculitis, Central Nervous System |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D002561 | Cerebrovascular Disorders |
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A single group is followed during 15 days with steroids treatment and the time until the halo disappears is monitored.
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| 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. | On Day 3 of corticosteroid therapy |
| Assessment of the number of patients with disappearance of the halo sign on Day 7 | On Day 7 of corticosteroid therapy |
| Assessment of the number of patients with disappearance of the halo sign on Day 15 | 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) | 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 | On Day 3 and Day 7 of corticosteroid therapy |
| Correlation between corticosteroid dose and disappearance of halo sign |
| From Day 0 to Day 15 |
| Number of patients on Tocilizumab with disappearance of Halo sign on Day 15 | On Day 15 of corticosteroid therapy |
| CHU d'Angers | Angers | 49100 | France |
|
| CHU Caen Normandie | Caen | 14000 | France |
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| CHU Dijon - Hôpital François Mitterrand | Dijon | 21000 | France |
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| Groupe hospitalier La Rochelle-Ré-Aunis | La Rochelle | 17000 | France |
|
| CHU Nantes | Nantes | 44000 | France |
|
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D001167 | Arteritis |
| D014657 | Vasculitis |
| D017445 | Skin Diseases, Vascular |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |