title: Is vascular endothelial growth factor a useful biomarker in giant cell arteritis?
abstract: OBJECTIVE
  To assess the performance of circulating vascular endothelial growth factor (VEGF) levels as a tool for diagnosing giant cell arteritis (GCA) in a cohort of patients referred for assessment of suspected GCA.
  
  
  METHODS
  We selected 298 patients recruited to the multicentre study Temporal Artery Biopsy versus Ultrasound in diagnosis of suspected GCA (TABUL). In a random subset of 26 biopsy-proven GCA cases and 26 controls, serum from weeks 0, 2 and 26 was analysed for VEGF concentration using ELISA. VEGF concentration at week 0 was used to generate a receiver-operating characteristic curve and thereby identify a cut-off for an abnormal result which was used to analyse the full patient cohort. Sections of paraffin-embedded temporal artery were stained by immunohistochemistry for VEGF.
  
  
  RESULTS
  The mean (95% CI) VEGF concentration at week 0 was 873 pg/mL (631 to 1110) in 26 patients versus 476 pg/mL (328 to 625) in 26 controls (p=0.017). This difference was not observed at any other time point. The optimal cut-off of 713 pg/mL was applied to the whole patient cohort (n=298), yielding sensitivity of 32% and specificity of 85%. This was not improved by combination with any clinical parameters. When patients with biopsy-proven GCA were compared with controls, sensitivity was 58% and specificity remained 85%. Sections of biopsy from biopsy-positive GCA showed intense staining in the adventitia which was not seen in controls.
  
  
  CONCLUSIONS
  Serum VEGF concentration predicts biopsy positivity but is not useful for differentiating clinical cases of GCA from controls. Further studies into VEGF as a prognostic marker and therapeutic target are warranted.
  
  
  BACKGROUND
  NCT00974883; Post-results.
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford , UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Goodfellow
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford , UK.
authors.forename: Julien
authors.initials: J
authors.lastname: Morlet
authors.affiliation: Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK.
authors.forename: Surjeet
authors.initials: S
authors.lastname: Singh
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford , UK.
authors.forename: Afsie
authors.initials: A
authors.lastname: Sabokbar
authors.affiliation: London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hutchings
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford , UK.
authors.forename: Vanshika
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford , UK.
authors.forename: Jana
authors.initials: J
authors.lastname: Vaskova
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford , UK.
authors.forename: Shauna
authors.initials: S
authors.lastname: Masters
authors.affiliation: Botnar Research Centre, University of Oxford, Oxford, UK.
authors.forename: Allahdad
authors.initials: A
authors.lastname: Zarei
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford , UK.
authors.forename: Raashid
authors.initials: R
authors.lastname: Luqmani
keywords: Giant Cell Arteritis; Inflammation; Systemic vasculitis