RT Journal Article
SR Electronic
T1 Association of Vascular Physical Examination Findings and Arteriographic Lesions in Large Vessel Vasculitis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.110652
DO 10.3899/jrheum.110652
A1 Peter C. Grayson
A1 Gunnar Tomasson
A1 David Cuthbertson
A1 Simon Carette
A1 Gary S. Hoffman
A1 Nader A. Khalidi
A1 Carol A. Langford
A1 Carol A. McAlear
A1 Paul A. Monach
A1 Philip Seo
A1 Kenneth J. Warrington
A1 Steven R. Ytterberg
A1 Peter A. Merkel
YR 2011
UL http://www.jrheum.org/content/early/2011/12/14/jrheum.110652.abstract
AB Objective To assess the utility of the vascular physical examination to detect arteriographic lesions in patients with established large vessel vasculitis (LVV), including Takayasu’s arteritis (TAK) and giant cell arteritis (GCA). Methods In total, 100 patients (TAK = 68, GCA = 32) underwent standardized physical examination and angiography of the carotid, subclavian, and axillary arteries. Sensitivity and specificity were calculated for the association between findings on physical examination focusing on the vascular system (absent pulse, bruit, and blood pressure difference) and arteriographic lesions defined as stenosis, occlusion, or aneurysm. Results We found 67% of patients had at least 1 abnormality on physical examination (74% TAK, 53% GCA). Arteriographic lesions were seen in 76% of patients (82% TAK, 63% GCA). Individual physical examination findings had poor sensitivity (range 14%–50%) and good-excellent specificity (range 71%–98%) to detect arteriographic lesions. Even when considering physical examination findings in combination, at least 30% of arteriographic lesions were missed. Specificity improved (range 88%–100%) if individual physical examination findings were compared to a broader region of vessels rather than specific anatomically correlated vessels and if ≥ 1 physical examination findings were combined. Conclusion In patients with established LVV, physical examination alone is worthwhile to detect arterial disease but does not always localize or reveal the full extent of arteriographic lesions. Abnormal vascular system findings on physical examination are highly associated with the presence of arterial lesions, but normal findings on physical examination do not exclude the possibility of arterial disease. Serial angiographic assessment is advisable to monitor arterial disease in patients with established LVV.