Prognostic value of quantifying vascular inflammation through ultrasound in patients with giant cell arteritis: the MAGiCUS study
Juan Molina-Collada, Sharon Cowley, Colm Kirby, David Kane, Patricia Harkins, Richard Conway, Isabel Castrejón, José María Álvaro-Gracia, Cristina Ponte, Sara Monti, Alessandra Milanesi, Edoardo Conticini, Francesco Placido, Yasser El Miedany, Irene Monjo-Henry, Roberto Padoan, Luca Iorio, Pierluigi Macchioni, Carlo Salvarani, Paula Estrada, Óscar Camacho, Rositsa Karalilova, Boris Blanco, Carmen Moragues, Milena Bond, Diana Prieto Peña, Julio Sánchez, Juan Jose de Agustín, Pablo Castro Santamaría, Antonio Mera Varela, Enrique Calvo-Aranda, Vanessa Quick, Pablo González Navarro, Perceval Vellosillo González, Christian Dejaco, Eugenio de Miguel,Abstract
Objectives
To assess the prognostic value of ultrasound-based quantification of vascular inflammation for predicting relapses in giant cell arteritis (GCA).
Methods
The Monitoring Activity of GCA through UltraSound (MAGiCUS) project is an international, multicentre, prospective, observational study including newly diagnosed GCA patients. Ultrasound of temporal and axillary arteries was conducted at baseline, 1, 3, 6, and 12 months. Vascular inflammation was quantified using the OMERACT GCA Ultrasonographic Score (OGUS). The primary outcome was the occurrence of the first clinical relapse between 6 and 12 months.
Results
Among 156 GCA patients from 19 centres, 31 (19.9%) experienced a relapse. In patients without a relapse, OGUS was significantly lower at all follow-up visits than baseline (-0.15 to -0.35). Baseline OGUS was significantly higher in relapsing patients (1.58 vs 1.16, p < 0.001). In multivariate analysis, an increase in 0.1 units in baseline OGUS was associated with relapse (OR 1.19, 95% CI 1.08, 1.34). This association remained significant for 0.1 increases in OGUS at 1 month (OR 1.37, 95% CI 1.17, 1.66) and at 3 months (OR 1.51, 95% CI 1.20, 1.98). The areas under the receiver operating characteristic curve for predicting relapse were 0.70 (95% CI 0.58 –0.80) for baseline OGUS, 0.74 (95% CI 0.60 –0.85) at 1 month, and 0.67 (95% CI 0.56 –0.78) at 3 months.
Conclusion
Ultrasound-based quantification of vascular inflammation has prognostic value for predicting relapses during follow-up in GCA. Higher baseline, 1-month and 3-months OGUS are associated with an increased probability of clinical relapse.