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Temporal ultrasonography findings in temporal arteritis: early disappearance of halo sign after only 2 days of steroid treatment

Temporal ultrasonography findings in temporal arteritis: early disappearance of halo sign after... Chia-Pi Cheng et al. in large osteoclasts could explain their excessive activity 49 Cantwell MJ, Hua T, Zvaifler NJ, Kipps TJ. Deficient Fas in osteolytic diseases. J Cell Biochem 2007;101:20520. ligand expression by synovial lymphocytes from patients with rheumatoid arthritis. Arthritis Rheum 1997;40: 46 Vignery A. Macrophage fusion: the making of osteoclasts 164452. and giant cells. J Exp Med 2005;202:33740. 47 Miyamoto K, Ninomiya K, Sonoda KH et al. MCP-1 ex- 50 Cheung TC, Coppieters K, Sanjo H et al. Polymorphic pressed by osteoclasts stimulates osteoclastogenesis in variants of light (TNF superfamily-14) alter receptor an autocrine/paracrine manner. Biochem Biophys Res avidity and bioavailability. J Immunol 2010;185: Commun 2009;383:3737. 194958. 51 You RI, Chang YC, Chen PM et al. Apoptosis of dendritic 48 Kim WU, Kwok SK, Hong KH et al. Soluble Fas ligand inhibits angiogenesis in rheumatoid arthritis. Arthritis Res cells induced by decoy receptor 3 (DcR3). Blood 2008; Ther 2007;9:R42. 111:14808. Rheumatology 2013;52:622 doi:10.1093/rheumatology/kes387 Clinical vignette Advance Access publication 7 January 2013 Temporal ultrasonography findings in temporal FIG.1 Right temporal artery CDU features before (A) and arteritis: early disappearance of halo sign after after (B) 2 days of steroid treatment. only 2 days of steroid treatment Temporal arteritis (TA) is the most common chronic sys- temic vasculitis, frequently involving superficial temporal arteries, hence the name. Diagnosis of TA is based on clinical, laboratory and histological findings, as recom- mended by the ACR criteria. Nevertheless, over the past few years colour Doppler ultrasonography (CDU) of tem- poral arteries has emerged as a valid non-invasive diag- nostic tool. The main specific CDU finding is the halo sign, a dark hypoechoic circumferential wall thickening around the artery lumen predominantly due to an acute inflamma- tory process of the arterial wall that tends to disappear a mean of about 2 weeks after the start of steroid treat- ment [1]. We observed the case of a 79-year-old woman with TA in which the halo sign disappeared after only 2 days of steroid treatment (Fig. 1). This case underlines that tem- poral CDU aspects have to be considered when perform- ing CDU of temporal arteries, making it desirable to perform this examination before starting steroid therapy. Considering that current guidelines are very clear about the importance of starting high-dose steroids immediately on suspicion of TA, CDU must be performed immediately rather than delaying steroids while this examination is being arranged. Disclosure statement: The authors have declared no conflicts of interest. Steroids induced early disappearance of the halo sign, leading to normalization of CDU. 1 1 Luca Santoro , Ferruccio D’Onofrio , 2 2 Simone Bernardi , Elisa Gremese , 2 1 Gianfranco Ferraccioli and Angelo Santoliquido 1 2 Department of Internal Medicine and Institute of Reference Rheumatology, Catholic University of Rome, Rome, Italy. 1 Schmidt WA, Kraft HE, Vorpahl K, Volker L, Correspondence to: Luca Santoro, Department of Internal Gromnica-Ihle EJ. Color duplex ultrasonography in the Medicine, Complesso Integrato Columbus, Catholic diagnosis of temporal arteritis. N Engl J Med 1997;337: University of Rome, Via Moscati 31, 00168 Rome, Italy. 133642. E-mail: [email protected] 622 www.rheumatology.oxfordjournals.org http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Rheumatology Oxford University Press

Temporal ultrasonography findings in temporal arteritis: early disappearance of halo sign after only 2 days of steroid treatment

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Publisher
Oxford University Press
Copyright
The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected]
ISSN
1462-0324
eISSN
1462-0332
DOI
10.1093/rheumatology/kes387
pmid
23300333
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Abstract

Chia-Pi Cheng et al. in large osteoclasts could explain their excessive activity 49 Cantwell MJ, Hua T, Zvaifler NJ, Kipps TJ. Deficient Fas in osteolytic diseases. J Cell Biochem 2007;101:20520. ligand expression by synovial lymphocytes from patients with rheumatoid arthritis. Arthritis Rheum 1997;40: 46 Vignery A. Macrophage fusion: the making of osteoclasts 164452. and giant cells. J Exp Med 2005;202:33740. 47 Miyamoto K, Ninomiya K, Sonoda KH et al. MCP-1 ex- 50 Cheung TC, Coppieters K, Sanjo H et al. Polymorphic pressed by osteoclasts stimulates osteoclastogenesis in variants of light (TNF superfamily-14) alter receptor an autocrine/paracrine manner. Biochem Biophys Res avidity and bioavailability. J Immunol 2010;185: Commun 2009;383:3737. 194958. 51 You RI, Chang YC, Chen PM et al. Apoptosis of dendritic 48 Kim WU, Kwok SK, Hong KH et al. Soluble Fas ligand inhibits angiogenesis in rheumatoid arthritis. Arthritis Res cells induced by decoy receptor 3 (DcR3). Blood 2008; Ther 2007;9:R42. 111:14808. Rheumatology 2013;52:622 doi:10.1093/rheumatology/kes387 Clinical vignette Advance Access publication 7 January 2013 Temporal ultrasonography findings in temporal FIG.1 Right temporal artery CDU features before (A) and arteritis: early disappearance of halo sign after after (B) 2 days of steroid treatment. only 2 days of steroid treatment Temporal arteritis (TA) is the most common chronic sys- temic vasculitis, frequently involving superficial temporal arteries, hence the name. Diagnosis of TA is based on clinical, laboratory and histological findings, as recom- mended by the ACR criteria. Nevertheless, over the past few years colour Doppler ultrasonography (CDU) of tem- poral arteries has emerged as a valid non-invasive diag- nostic tool. The main specific CDU finding is the halo sign, a dark hypoechoic circumferential wall thickening around the artery lumen predominantly due to an acute inflamma- tory process of the arterial wall that tends to disappear a mean of about 2 weeks after the start of steroid treat- ment [1]. We observed the case of a 79-year-old woman with TA in which the halo sign disappeared after only 2 days of steroid treatment (Fig. 1). This case underlines that tem- poral CDU aspects have to be considered when perform- ing CDU of temporal arteries, making it desirable to perform this examination before starting steroid therapy. Considering that current guidelines are very clear about the importance of starting high-dose steroids immediately on suspicion of TA, CDU must be performed immediately rather than delaying steroids while this examination is being arranged. Disclosure statement: The authors have declared no conflicts of interest. Steroids induced early disappearance of the halo sign, leading to normalization of CDU. 1 1 Luca Santoro , Ferruccio D’Onofrio , 2 2 Simone Bernardi , Elisa Gremese , 2 1 Gianfranco Ferraccioli and Angelo Santoliquido 1 2 Department of Internal Medicine and Institute of Reference Rheumatology, Catholic University of Rome, Rome, Italy. 1 Schmidt WA, Kraft HE, Vorpahl K, Volker L, Correspondence to: Luca Santoro, Department of Internal Gromnica-Ihle EJ. Color duplex ultrasonography in the Medicine, Complesso Integrato Columbus, Catholic diagnosis of temporal arteritis. N Engl J Med 1997;337: University of Rome, Via Moscati 31, 00168 Rome, Italy. 133642. E-mail: [email protected] 622 www.rheumatology.oxfordjournals.org

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Rheumatology – Oxford University Press

Published: Apr 7, 2013

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