Is Erythrocyte Sedimentation Rate Necessary for the Initial Diagnosis of Giant Cell Arteritis?

Author:

Hansen Michael S.1ORCID,Klefter Oliver N.1ORCID,Terslev Lene2,Jensen Mads R.3,Brittain Jane M.4,Døhn Uffe M.2,Faber Carsten1ORCID,Heegaard Steffen15,Wiencke Anne K.1ORCID,Subhi Yousif16ORCID,Hamann Steffen1ORCID

Affiliation:

1. Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark

2. Center for Rheumatology and Spine Diseases, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark

3. Department of Clinical Physiology and Nuclear Medicine, Bispebjerg & Frederiksberg Hospital, DK-2400 Copenhagen, Denmark

4. Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, DK-2100 Copenhagen, Denmark

5. Eye Pathology Section, Department of Pathology, Rigshospitalet, DK-2100 Copenhagen, Denmark

6. Department of Clinical Research, University of Southern Denmark, DK-5230 Odense, Denmark

Abstract

Giant cell arteritis (GCA) is an ophthalmological emergency that can be difficult to diagnose and prompt treatment is vital. We investigated the sequential diagnostic value for patients with suspected GCA using three biochemical measures as they arrive to the clinician: first, platelet count, then C-reactive protein (CRP), and lastly, erythrocyte sedimentation rate (ESR). This retrospective cross-sectional study of consecutive patients with suspected GCA investigated platelet count, CRP, and ESR using diagnostic test accuracy statistics and odds ratios (ORs) in a sequential fashion. The diagnosis was established by experts at follow-up, considering clinical findings and tests including temporal artery biopsy. A total of 94 patients were included, of which 37 (40%) were diagnosed with GCA. Compared with those without GCA, patients with GCA had a higher platelet count (p < 0.001), CRP (p < 0.001), and ESR (p < 0.001). Platelet count demonstrated a low sensitivity (38%) and high specificity (88%); CRP, a high sensitivity (86%) and low specificity (56%); routine ESR, a high sensitivity (89%) and low specificity (47%); and age-adjusted ESR, a moderate sensitivity (65%) and moderate specificity (65%). Sequential analysis revealed that ESR did not provide additional value in evaluating risk of GCA. Initial biochemical evaluation can be based on platelet count and CRP, without waiting for ESR, which allows faster initial decision-making in GCA.

Funder

Synoptik Foundation and the Danish Rheumatism Association

Publisher

MDPI AG

Subject

Paleontology,Space and Planetary Science,General Biochemistry, Genetics and Molecular Biology,Ecology, Evolution, Behavior and Systematics

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