Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Association between Vascular Physical Examination Findings and Angiographically-Detected Arterial Lesions in Subjects with Large Vessel Vasculitis.
Grayson4, Peter C., Tomasson3, Gunnar, Cuthbertson11, David, Carette9, Simon, Hoffman6, Gary S., Khalidi10, Nader A., Langford5, Carol A.
Boston University, Boston, MA
University of Hamilton, Hamilton, ON, Canada
University of South Florida
Boston University School of Medicine, West Newton, MA
Boston University School of Medicine, Boston, MA
Boston University School of Medicine
Cleveland Clinic Foundation, Cleveland, OH
Cleveland Clinic Foundation, Pepper Pike, OH
Johns Hopkins Bayview Medical Center, Baltimore, MD
Mayo Clinic, Rochester, MN
Toronto Western Hospital, Toronto, ON, Canada
The vascular physical examination (PE) to assess for pulses, bruits, and systolic blood pressure (SBP) readings is considered essential in the clinical evaluation of patients with large vessel vasculitis (LVV), including Takaysu's arteritis (TAK) and giant cell arteritis (GCA). This study examined the relationship between findings on PE and angiographic-detected arterial lesions in subjects with established LVV.
100 subjects (TAK=68, GCA=32) enrolled in a longitudinal, observational cohort underwent standardized PE and magnetic resonance angiography of the aorta and its primary branches. Analysis was restricted to bilateral common carotid, subclavian, and axillary arteries. Sensitivity and specificity was calculated for the association between PE findings (absent pulse, bruit, and inter-arm SBP difference) and angiographic lesions defined as stenosis, occlusion, or aneurysm. To determine if PE findings accurately localized arterial lesions, a PE finding (e.g. left carotid bruit) was compared to angiogram findings in both the anatomically correlated vessel (e.g. left carotid artery) and in all vessels within the region (carotid or subclavian or axillary arteries).
Participants were predominantly female (92%), Caucasian (87%), and had mean ages of 40 years (TAK) and 69 years (GCA). 67% had at least one PE abnormality: absent pulse (41%-TAK, 38%-GCA), bruit (54%-TAK, 28%-GCA), or >= 15 mmHg SBP difference (52%-TAK, 29%-GCA). Lesions in any of the carotid, subclavian, or axillary arteries were detected in 75% of subjects (82%-TAK, 59%-GCA). Individual PE findings had poor sensitivity (range 1451%) and good-excellent specificity (range 7298%) to detect arterial lesions. Sensitivity improved (range 5271%) and specificity worsened (range 5986%) if any of the 3 different PE maneuvers considered in combination were abnormal. Sensitivity worsened (range 630%) and specificity improved (range 88100%) if 2 or more of the PE findings were abnormal or if individual PE findings were compared to regional vessels without imposing single vessel anatomic correlation.
In subjects with established LVV, vascular PE findings have low sensitivity but high specificity to detect arterial disease. Abnormal PE findings are highly associated with the presence of arterial lesions, but normal PE findings do not rule out the possibility of arterial disease. Even when considering PE findings in combination, sensitivity is still inadequate to rule out arterial lesions. Specificity improves when PE findings are evaluated in association with a broader region of arterial lesions rather than a specific anatomically correlated vessel, suggesting that PE findings do not always accurately localize disease. While valuable in the assessment of arterial disease in LVV, the PE should not form the sole basis of assessment and should be supplemented by angiography.
To cite this abstract, please use the following information:
Grayson, Peter C., Tomasson, Gunnar, Cuthbertson, David, Carette, Simon, Hoffman, Gary S., Khalidi, Nader A., et al; Association between Vascular Physical Examination Findings and Angiographically-Detected Arterial Lesions in Subjects with Large Vessel Vasculitis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2198