Document Detail


Association of vascular physical examination findings and arteriographic lesions in large vessel vasculitis.
MedLine Citation:
PMID:  22174204     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Peter C Grayson; Gunnar Tomasson; David Cuthbertson; Simon Carette; Gary S Hoffman; Nader A Khalidi; Carol A Langford; Carol A McAlear; Paul A Monach; Philip Seo; Kenneth J Warrington; Steven R Ytterberg; Peter A Merkel;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-12-15
Journal Detail:
Title:  The Journal of rheumatology     Volume:  39     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-02     Completed Date:  2012-06-05     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  303-9     Citation Subset:  IM    
Affiliation:
Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Aneurysm / radiography
Angiography
Axillary Artery / radiography
Carotid Arteries / radiography
Child
Constriction, Pathologic / radiography
Female
Giant Cell Arteritis / diagnosis*,  radiography
Humans
Male
Middle Aged
Physical Examination
Sensitivity and Specificity
Subclavian Artery / radiography
Takayasu Arteritis / diagnosis*,  radiography
Young Adult
Grant Support
ID/Acronym/Agency:
AR 007598/AR/NIAMS NIH HHS; M01 RR000533/RR/NCRR NIH HHS; M01 RR001066/RR/NCRR NIH HHS; T32 AR007598/AR/NIAMS NIH HHS; U01 AR51874/AR/NIAMS NIH HHS; U54 AR057319/AR/NIAMS NIH HHS; U54 RR019497/RR/NCRR NIH HHS; U54 RR019497/RR/NCRR NIH HHS; U54AR057319/AR/NIAMS NIH HHS
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