title: Association of vascular physical examination findings and arteriographic lesions in large vessel vasculitis.
abstract: 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.
  
  
  CONCLUSIONS
  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.affiliation: Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Grayson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Tomasson
authors.forename: David
authors.initials: D
authors.lastname: Cuthbertson
authors.forename: Simon
authors.initials: S
authors.lastname: Carette
authors.forename: Gary S
authors.initials: GS
authors.lastname: Hoffman
authors.forename: Nader A
authors.initials: NA
authors.lastname: Khalidi
authors.forename: Carol A
authors.initials: CA
authors.lastname: Langford
authors.forename: Carol A
authors.initials: CA
authors.lastname: McAlear
authors.forename: Paul A
authors.initials: PA
authors.lastname: Monach
authors.forename: Philip
authors.initials: P
authors.lastname: Seo
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Warrington
authors.forename: Steven R
authors.initials: SR
authors.lastname: Ytterberg
authors.forename: Peter A
authors.initials: PA
authors.lastname: Merkel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging; D000792:Angiography; D001366:Axillary Artery / Q000000981:diagnostic imaging; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002648:Child; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D013700:Giant Cell Arteritis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D012680:Sensitivity and Specificity; D013348:Subclavian Artery / Q000000981:diagnostic imaging; D013625:Takayasu Arteritis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D055815:Young Adult