Czihal et al reported a diagnostic algorithm for the diagnosis of cranial giant cell arteritis. The authors are from Ludwig-Maximilians University in Munich.
Parameters for clinical prediction model:
(1) age of the patient in years
(2) new onset of a persistent headache
(3) jaw claudication
(4) permanent vision loss due to anterior ischemic optic neuropathy (AION)
(5) serum CRP in mg/dL
(6) temporal artery wall thickness on high-resolution compression sonography
Parameter
Finding
Points
age
<= 70 years
0
> 70 years
1
new persistent headache
no
0
yes
1
jaw claudication
no
0
yes
1
AION
no
0
unilateral
1
bilateral
2
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 5 (paper says 6 but this requires counting both unilateral and bilateral AION)
• A score >= 2 indicates high clinical probability.
• A score < 2 indicates low clinical probability.
Clinical Probability
Serum CRP
TA Wall Thickness Compression Sonography
Cranial GCA (cCGA)
low
< 2.5 mg/dL
NA
no cGCA
low
>= 2.5 mg/dL
< 0.7 mm
no cGCA
low
>= 2.5 mg/dL
>= 0.7 mm
cGCA
high
NA
< 0.7 mm
no cGCA
high
NA
>= 0.7 mm
cGCA
Performance:
• The authors report an area under the ROC curve of 0.96 and 0.92 in testing cohorts.
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