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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Ultrasonography To Diagnose Giant-Cell Arteritis
1 March 2005 | Volume 142 Issue 5 | Page I-44
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Meta-Analysis: Test Performance of Ultrasonography for Giant-Cell Arteritis." It is in the 1 March 2005 issue of Annals of Internal Medicine (volume 142, pages 359-369). The authors are F.B. Karassa, M.I. Matsagas, W.A. Schmidt, and J.P.A. Ioannidis.
What is the problem and what is known about it so far?
Giant-cell arteritis is a condition that involves inflammation of arteries. It is more common with older age and rarely occurs before age 60 years. Another name for the condition is temporal arteritis because it most often involves the temporal arteries. The temporal arteries are located on the sides of the forehead. Inflammation of the arteries can cause them to narrow and can block normal blood flow to areas of the body that the arteries serve. Symptoms of giant-cell arteritis include head, face, jaw, or scalp pain; fever; fatigue; and loss of appetite. A serious complication of giant-cell arteritis is loss of vision. Timely diagnosis and treatment with steroid medications can prevent this. However, the high doses of steroid medications necessary to treat giant-cell arteritis can have side effects, so doctors want to be certain that patients have the condition before prescribing a long course of treatment. Treatment after loss of vision occurs will not restore normal vision but can prevent further vision loss. Unfortunately, giant-cell arteritis can be difficult to diagnose without doing a biopsy of the temporal artery. A biopsy is a minor surgical procedure that allows doctors to obtain a piece of tissue to examine under a microscope. Some reports have suggested that ultrasound tests of the temporal artery can be helpful in diagnosing giant-cell arteritis, but the role of ultrasonography in diagnosing this condition remains uncertain. Ultrasonography involves using sound waves to take special pictures.
Why did the authors do this review?
To see whether available studies suggest that ultrasonography can help in the diagnosis of giant-cell arteritis.
How did the authors do this review?
The authors reviewed computerized databases of medical reports and published studies and contacted researchers to identify all studies that examined temporal artery ultrasonography for the diagnosis of giant-cell arteritis. They included only studies that enrolled at least 5 patients and used an accepted method to confirm temporal arteritis. The authors used statistical methods to combine the results of the studies they found.
What did the authors find?
Twenty-three studies met the authors' criteria. After combining the study results, the authors found that ultrasonography is most helpful for ruling out giant-cell arteritis in patients who have a low chance of having the disease. Their findings suggested that ultrasonography was of only limited usefulness in patients who had a high chance of having the disease.
What were the limitations of the review?
The 23 studies had different methods, so the findings that came from combining their results may be somewhat imprecise.
What are the implications of the review?
Ultrasonography may help doctors rule out giant-cell arteritis in patients who have a low chance of actually having the disease, such as patients who have only 1 of the symptoms. Doctors will have to continue to rely heavily on symptoms and biopsy when trying to determine whether a patient has giant-cell arteritis.
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