Peter M Andel

Bio: Peter M Andel is an academic researcher from Hospital of Southern Norway. The author has contributed to research in topics: Medicine & Fast track. The author has an hindex of 1, co-authored 1 publications receiving 1 citations.

Diagnosing giant cell arteritis: a comprehensive practical guide for the practicing rheumatologist

Abstract: GCA is the most common large vessel vasculitis in the elderly population. In recent years, advanced imaging has changed the way GCA can be diagnosed in many locations. The GCA fast-track clinic approach combined with US examination allows prompt treatment and diagnosis with high certainty. Fast-track clinics have been shown to improve prognosis while being cost effective. However, all diagnostic modalities are highly operator dependent, and in many locations expertise in advanced imaging may not be available. In this paper, we review the current evidence on GCA diagnostics and propose a simple algorithm for diagnosing GCA for use by rheumatologists not working in specialist centres.

Recurrent pericarditis.

Abstract: Pericarditis is an important differential diagnosis in patients with chest pain. The two most common causes in the developed world are idiopathic pericarditis and inflammation following cardiac surgery or myocardial infarction. Recurrence of pericarditis affects up to 30 % of patients, half of whom experience multiple episodes, and approximately 10 % develop steroid-dependent and colchicine-refractory pericarditis. Recurrence is due to autoinflammatory processes in the pericardium. Advanced diagnostic imaging and treatment with colchicine and interleukin-1 inhibitors has helped reduce morbidity considerably in recent years. In this clinical review, we summarise up-to-date knowledge about the diagnostic evaluation and treatment of patients with recurrent primary pericarditis.

Comment on: Diagnosing giant cell arteritis: a comprehensive practical guide for the practicing rheumatologist: reply.

Abstract: Dear Editor, We thank Quick et al. for the very valuable comments on our article ‘Diagnosing giant cell arteritis: a comprehensive practical guide for the practicing rheumatologist’ [1]. There is, as Quick et al. rightly point out, no uniform definition of fast-track clinic in GCA [1]. However, existing evidence, as well as American and European guidelines, supports treatment with CSs to avoid potential ischaemic complications as soon as GCA is suspected [2–4]. Consequently, Quick et al. discuss that prompt treatment and a short delay to informed expert evaluation in an appropriate setting might be worthwhile, as the emergency department is a suboptimal environment to properly evaluate the patient’s history and seldom hosts the expert skills required to establish the diagnosis [1]. We uniformly agree that immediate treatment is the most important step in avoiding complications, and fast track clinics can help...

Extended ultrasound examination identifies more large vessel involvement in patients with giant cell arteritis.

Abstract: OBJECTIVES To compare limited, to a more extended ultrasound examination (anteromedial ultrasound, A2-ultrasound) to detect large vessels (LV) involvement in patients with newly diagnosed giant cell arteritis (GCA). METHODS Patients with new-onset GCA were included at the time of diagnosis. All patients were examined using limited ultrasound (ultrasound of the axillary artery as visualized in the axilla), and extended A2-ultrasound method (which also includes the carotid, vertebral, subclavian, and proximal axillary arteries), in addition to the temporal artery ultrasound. RESULTS One hundred and thirty-three patients were included in the study. All patients fulfilled the criteria according to a proposed extension of the 1990 American College of Rheumatology (ACR) classification criteria for GCA and had a positive ultrasound examination at diagnosis. Ninety-three of the 133 GCA patients (70,0%) had LV involvement when examined by extended A2-ultrasound, compared with only 56 patients (42,1%) by limited ultrasound (p< 0,001). Twelve patients (9.0%) had vasculitis of the vertebral arteries as the only LV involved. Five patients (3,8%) would have been missed as having GCA if only limited ultrasound was performed. Forty patients (30,0%) had isolated cranial GCA (c-GCA), 21 patients (15,8%) had isolated large vessel GCA (LV-GCA), and 72 patients (54,1%) had mixed-GCA. CONCLUSION Extended A2-ultrasound examination, identified more patients with LV involvement than limited ultrasound method. However, extended A2-ultrasound requires high expertise and high-end equipment and should be performed by ultrasonographers with adequate training.

Diagnostic accuracy of vascular ultrasound in patients with suspected giant cell arteritis (EUREKA): a prospective, multicentre, non-interventional, cohort study

Abstract: Summary Background Temporal artery biopsy is considered the diagnostic gold standard for giant cell arteritis, despite approximately 39% of patients who are negative for the condition by biopsy subsequently being given a clinical diagnosis of giant cell arteritis. We aimed to assess the diagnostic accuracy of ultrasound examination in patients with suspected giant cell arteritis. Methods In this prospective, multicentre, non-interventional, cohort study (evaluation of ultrasound's role in patients suspected of having extracranial and cranial giant cell arteritis; EUREKA), we consecutively recruited patients aged 50 years or older, with clinically suspected giant cell arteritis from three Danish hospitals (South West Jutland Hospital in Esbjerg, Silkeborg Regional Hospital, and Rigshospitalet, Glostrup). Participants had a bilateral ultrasound of the temporal, facial, common carotid, and axillary arteries. Ultrasounds were done by ultrasonographers who were systematically trained in vascular ultrasound using appropriate equipment and settings. Participants then had a temporal artery biopsy within 7 days of initiation of corticosteroid treatment. A blinded ultrasound expert assessed all ultrasound images. Ultrasound vasculitis was defined in cranial arteries as a homogeneous, hypoechoic, intimamedia complex thickness and a positive compression sign and as a homogeneous intimamedia complex of 1 mm in thickness or wider in the axillary arteries and of 1·5 mm thickness or wider in the common carotid artery. Participants were followed up at 6 months. During this 6 month period, clinicians were able to collect data from all clinical examinations to enable a full clinical diagnosis at 6 months. Clinical diagnosis was based on the expert opinion of the treating rheumatologist. The diagnostic criterion standard was diagnosis confirmed after 6 months of follow-up. We used logistic regression analyses to calculate the odds ratio and 95% CI of ultrasound as a predictor for giant cell arteritis. Findings Between April 1, 2014, and July 31, 2017, 118 patients were screened for inclusion, of whom 106 had both ultrasound examinations and an eligible temporal artery biopsy and were included in the intention-to-diagnose population. The mean age was 72·7 years (SD 7·9), 63 (59%) participants were women, and 43 (41%) were men. Temporal artery biopsy was positive in 46 (43%) of 106 patients, and 62 (58%) of 106 patients had a clinically confirmed diagnosis of giant cell arteritis at 6 months (temporal artery biopsy sensitivity 74% [95% CI 62–84], specificity 100% [95% CI 92–100]). Cranial artery ultrasound was positive in all patients who had a positive temporal artery biopsy, and seven (58%) of 12 patients who were positive by ultrasound and negative by temporal artery biopsy were confirmed to have large-vessel giant cell arteritis via other imaging methods. The sensitivity of ultrasound diagnosis of giant cell arteritis was 94% (84–98) and specificity was 84% (70–93). Logistic regression analysis confirmed that ultrasound was the strongest baseline predictor for a clinically confirmed diagnosis of giant cell arteritis at 6 months (crude odds ratio 76·6 [95% CI 21·0–280·0]; adjusted for sex and age 141·0 [27·0–743·0]). Interpretation Vascular ultrasound might effectively replace temporal artery biopsy as a first-line diagnostic method in patients suspected of having giant cell arteritis when done by systematically trained ultrasonographers using appropriate equipment and settings. Funding The Institute for Regional Research at Hospital of Southwest Jutland, Esbjerg, Denmark.

Norwegian society of rheumatology recommendations on diagnosis and treatment of patients with giant cell arteritis

Abstract: Objective To provide clinical guidance to Norwegian Rheumatologists and other clinicians involved in diagnosing and treating patients with giant cell arteritis (GCA). Methods The available evidence in the field was reviewed, and the GCA working group wrote draft guidelines. These guidelines were discussed and revised according to standard procedures within the Norwegian Society of Rheumatology. The European Alliance of Associations for Rheumatology (EULAR) recommendations for imaging and treatment in large vessel vasculitis and the British Society for Rheumatology (BSR) guidelines for diagnostics and treatment in GCA informed the development of the current guidelines. Results A total of 13 recommendations were developed. Ultrasound is recommended as the primary diagnostic test. In patients with suspected GCA, treatment with high doses of Prednisolone (40–60 mg) should be initiated immediately. For patients with refractory disease or relapse, Methotrexate (MTX) should be used as the first-line adjunctive therapy, followed by tocilizumab (TCZ). Conclusion Norwegian recommendations for diagnostics and treatment to improve management and outcome in patients with GCA were developed.

Current developments in the diagnosis and treatment of giant cell arteritis

Abstract: Giant cell arteritis is the most common vasculitis in adults above 50 years old. The disease is characterized by granulomatous inflammation of medium and large arteries, particularly the temporal artery, and is associated acutely with headache, claudication, and visual disturbances. Diagnosis of the disease is often complicated by its protean presentation and lack of consistently reliable testing. The utility of color doppler ultrasound at the point-of-care and FDG-PET in longitudinal evaluation remain under continued investigation. Novel techniques for risk assessment with Halo scoring and stratification through axillary vessel ultrasound are becoming commonplace. Moreover, the recent introduction of the biologic tocilizumab marks a paradigm shift toward using glucocorticoid-sparing strategies as the primary treatment modality. Notwithstanding these developments, patients continue to have substantial rates of relapse and biologic agents have their own side effect profile. Trials are underway to answer questions about optimal diagnostic modality, regiment choice, and duration.

Diagnostic Modalities in Giant Cell Arteritis

Abstract: Andersen, Tomas MD, MPH; Tamhankar, Madhura A. MD; Song, Jae W. MD, MS Author Information