Dr. Koster et al, aptly call attention to the distinction in diagnostic and classification
criteria and comment criteria proposed by Dejaco and colleagues
1
were to advise updates for criteria for classification not diagnosis. While true,
Dejaco et al.
2
state “The objective of this project was to provide user-friendly, evidence-based
recommendations for the use of imaging modalities for diagnosis, monitoring and outcome
of primary LVV”. In their discussion they note, “In summary, we developed 12 recommendations
on the use of imaging for the diagnosis and monitoring of LVV”. Our goal was not to
“distract from the rigors of decision making,” but to broaden the diagnostic capability
afforded by advances in extracranial large vessel imaging underappreciated in the
diagnosis in GCA. Our patient was seen by multiple internists, rheumatologists, and
stroke neurologists before diagnosed months later with GCA based on large vessel imaging.
Understanding and applying the recommended diagnostic imaging
1
in the appropriate clinical setting proved helpful to our patient.To read this article in full you will need to make a payment
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References
- The spectrum of giant cell arteritis and polymyalgia rheumatica: revisiting the concept of the disease.Rheumatology. 2017; 56: 506-515
- EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice.Ann Rheum Dis. 2018; 77: 636-643
Article info
Publication history
Published online: October 20, 2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106810
Copyright
© 2022 Published by Elsevier Inc.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Distinction between diagnostic and classification criteria: a comment on ‘Biopsy negative giant cell arteritis – Revised diagnostic criteria: Giant cell arteritis diagnostic criteria’Journal of Stroke and Cerebrovascular DiseasesVol. 31Issue 12
- PreviewWe read with interest the case reported by Dr. Paquale Finelli1 which highlighted the importance of evaluating patients with non-invasive arterial imaging to identify radiographic features of large-vessel vasculitis (LVV). We agree with the author that evaluating for extracranial LVV is advised among patients presenting with stroke, elevated inflammatory markers, systemic inflammatory symptoms, and absence of traditional vascular risk factors; particularly if a thromboembolic source is not identified.
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