FRI0195 ULTRASONOGRAPHIC HALO SCORE ASSOCIATES WITH INTIMAL HYPERPLASIA IN GIANT CELL ARTERITIS
Authors: K. Van der Geest, F. Borg, K. Wolfe, W. A. Schmidt, R. Luqmani, B. Dasgupta
Journal: Annals of the Rheumatic Diseases (2020)

Background: We have recently developed a novel ultrasonographic Halo Score to quantify the extent of vascular inflammation in GCA [1]. High Halo Scores were associated with a high rate of ocular ischaemia among patients with GCA. Earlier studies have shown that GCA patients with intimal hyperplasia in their temporal artery biopsy (TAB) are at the highest risk of neuro-ophthalmic, ischaemic complications [2,3]. We therefore questioned whether the ultrasonographic Halo Score might be linked to the presence of intimal hyperplasia in patients with GCA. Objectives: To investigate the relationship between the ultrasonographic Halo Score and intimal hyperplasia. Methods: This is a prospective study including 92 patients suspected of having GCA, who underwent both ultrasound of temporal/axillary arteries and TAB at diagnosis. Ultrasonographic halo counts and Halo Scores were determined [1]. An experienced pathologist determined whether or not the TAB findings were consistent with GCA. TABs were systematically evaluated for the presence of a transmural infiltrate and intimal hyperplasia. Multiple linear regression analysis was performed with either halo counts or Halo Scores as the dependent variable. Predictive variables included the presence of a transmural TAB infiltrate, intimal hyperplasia and male sex. Results: The TAB was consistent with GCA in 27 patients. The TAB revealed transmural inflammation in 18 patients and giant cells in 24 patients. Intimal hyperplasia was found in 20 patients with a positive TAB. Patients with a positive TAB showed higher halo counts and Halo Scores than patients with a negative TAB. Overall, patients with a positive TAB and intimal hyperplasia presented with the highest halo counts and Halo Scores (Figure). Among patients with a positive TAB, only intimal hyperplasia and male sex were predictive of higher halo counts and Halo Scores in the multiple linear regression analysis. Ocular ischaemia was present in 14% of patients with a positive TAB without intimal hyperplasia. However, 40% of patients with a positive TAB and intimal hyperplasia suffered from ocular ischaemia. Conclusion: The ultrasonographic Halo Score is strongly influenced by the presence of intimal hyperplasia, a TAB feature that associates with cranial ischemic complications in patients with GCA [2,3]. References: [1]van der Geest KSM, Borg F, Kayani A, Paap D, Gondo P, Schmidt W, et al. Novel ultrasonographic Halo Score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia. Annals of the Rheumatic Diseases 2020 Jan 3. [2]Makkuni D, Bharadwaj A, Wolfe K, Payne S, Hutchings A, Dasgupta B. Is intimal hyperplasia a marker of neuro-ophthalmic complications of giant cell arteritis? Rheumatology (Oxford, England) 2008 Apr;47(4):488-490. [3]Kaiser M, Weyand CM, Bjornsson J, Goronzy JJ. Platelet-derived growth factor, intimal hyperplasia, and ischemic complications in giant cell arteritis. Arthritis and Rheumatism 1998 Apr;41(4):623-633. Figure Disclosure of Interests: Kornelis van der Geest Speakers bureau: Roche (2019), Frances Borg: None declared, Konrad Wolfe: None declared, Wolfgang A. Schmidt Grant/research support from: GSK, Novartis, Roche, Sanofi, Consultant of: GSK, Novartis, Roche, Sanofi, Chugai, Raashid Luqmani Grant/research support from: Arthritis UK, the Medical Research Council, the University of California San Francisco/Oxford Invention Fund, the Canadian Institutes of Health Research, The Vasculitis Foundation, GSK, Consultant of: GSK, Medpace, MedImmune, Roche, Bhaskar Dasgupta Grant/research support from: Roche, Consultant of: Roche, Sanofi, GSK, BMS, AbbVie, Speakers bureau: Roche