Infectious Disease

The ‘guidelines’ can assist distinguish overlapping options from COVID-19, big cell arteritis

February 08, 2021

3 min read

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Disclosure:
Mackie reports consulting fees and assistance for attending EULAR 2019 from Roche as well as examining clinical trials in GCA for Sanofi, Roche and GlaxoSmithKline. Mackie’s institution received consulting fees from Roche and Sanofi. In the study you will find all relevant financial information from all other authors.

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Giant cell arteritis and COVID-19 both have headache, fever, elevated C-reactive protein, and cough as symptoms, while jaw claudication, vision loss, and platelet and lymphocyte counts can be more discriminatory, according to the findings.

“GCA is a medical emergency and urgently needs to be examined by a specialist such as a rheumatologist or ophthalmologist.” Sarah L. Mackie, PhD, from the University of Leeds, said Healio Rheumatology. “Headache is a very common symptom of the GCA, but during the 2020 pandemic we found that headache is also a common early symptom of COVID-19. In the UK, headache is still not one of the “official” symptoms allowing people to access community COVID tests. During the first peak of the pandemic, we were referred to several patients with suspected giant cell arteritis who actually had COVID-19. “

“During the first peak of the pandemic, we were referred to several patients with suspected giant cell arteritis who actually had COVID-19,” said Dr. Sarah L. Mackie to Healio Rheumatology. Source: Adobe Stock

“Our first line test that is checked for GCA after blood tests are ultrasound of the temporal artery,” she added. “This ultrasound examination requires close proximity between the patient and the sonographer for half an hour or more. The scan takes place in a small room with many surfaces that take some time to thoroughly clean. It is not an ideal situation when the patient actually has COVID-19. I wanted to create a checklist for members of the team to help them clinically assess the likelihood of a patient having a GCA compared to COVID-19. “

To identify the common and different characteristics of GCA and COVID-19 and ultimately avoid diagnostic errors, Mehta and colleagues performed two systemic literature reviews that focused on the frequency of symptoms. For the GCA review, researchers searched PubMed, Embase, and the Cochrane Database of Systematic Reviews to identify studies in which consecutive patients with suspected GCA were recruited. This review produced 1,666 results, of which 35 studies were included for analysis.

In the meantime, for the COVID-19 review, Mehta and colleagues identified any cohorts or case series published between January 1, 2020 and April 5, 2020 describing patients diagnosed with the disease. Retrospective case series with fewer than 50 patients and those in which all patients died, were in intensive care, or had a specific comorbidity such as cancer were excluded. The search included PubMed, Embase, and the Cochrane Database of Systematic Reviews. A total of 211 COVID-19 studies were identified. Of these, 29 studies with a total of 5,623 patients were included for analysis.

For each publication included, researchers recorded the reported frequencies of each symptom, sign, or laboratory feature. In addition, they used medians and ranges to summarize the incidence for each disease.

According to the researchers, headaches were common with GCA with a frequency of 66%, but were also seen with COVID-19 with a frequency of 10%. Jaw claudication or vision loss – seen in 43% and 26% of GCA cases, respectively – were generally not detected in COVID-19. Both GCA and COVID-19 showed fatigue – 38% versus 43% – and elevated markers of inflammation, including C-reactive protein, which was elevated in 100% of GCA cases and 66% of COVID-19 cases. However, the platelet count was increased in 47% of GCA cases, but only in 4% of patients with COVID-19.

Patients with COVID-19 had a common cough – 63% of cases – and fever – 83% of cases – while patients with GCA had these symptoms less often, with an incidence of 12% for cough and 27% for fever.

Gastrointestinal disturbances have been reported in 8% of COVID-19 cases and 4% of GCA cases. Lymphopenia was now present in 53% of patients with COVID-19, compared with 2% of GCA cases. Loss of changes in the sense of smell or taste has been reported in the GCA, but its frequency is unclear, the researchers wrote.

“We are still using the checklist in our Leeds clinical practice,” said Mackie. “It does not govern clinical management, but it does promote a systematic approach to identifying information relevant to clinical decision-making, is a good aid to communication between team members, and provides information on what decision was made at the time of assessment . We wanted to share our learning in case others want to adapt this approach in their own centers. “

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