Evaluación de técnicas diagnósticas en dos enfermedades inflamatorias causantes de neuropatía óptica: arteritis de células gigantes y esclerosis múltiple recurrente-remitente
- Autores: Julio José González López
- Directores de la Tesis: Gema Rebolleda Fernández (dir. tes.), Francisco José Muñoz Negrete (codir. tes.)
- Lectura: En la Universidad de Alcalá ( España ) en 2015
- Idioma: español
- Tribunal Calificador de la Tesis: José Manuel Benítez del Castillo Sánchez (presid.), Marta Suárez de Figueroa Díez (secret.), J. Salgado Borges (voc.), Juan Murube del Castillo (voc.), José Luis Encinas Martín (voc.)
- Materias:
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- Resumen
Objectives: To evaluate the positivity rate of temporal artery biopsies (TAB) performed in suspects of giant cell arteritis (GCA) and to study the epidemiological and clinical factors associated to the biopsy result.To evaluate the agreement of retinal nerve fiber layer (RNFL) color codes among Stratus, Cirrus, and Spectralis optical coherence tomography (OCT) in patients with relapsing-remitting multiple sclerosis (RRMS), and to estimate the sensitivity and specificity of a series of ganglion cell-inner plexiform layer (GCIPL) thickness and peripapillary retinal nerve fiber layer (pRNFL) thickness for the detection of retinal thickness changes in these eyes.
Methods: A retrospective, multicenter, case-control study was performed, including three hundred and thirty-five patients who underwent TAB for a suspicion of GCA from 2001 to 2010. Clinical, epidemiological and pathology data were recovered from the patients clinical records. Histologic diagnosis of GCA was made when active inflammation or giant cells were found in the arterial wall.A prospectively recruited, cross-sectional evaluation of a diagnostic test was performed. Both eyes of seventy patients with RRMS and seventy age- and gender-matched healthy subjects were included. Participants underwent pRNFL and GCIPL thickness analysis using Cirrus OCT and pRNFL using Stratus and Spectralis OCT. Sensitivities and specificities of Cirrus OCT GCIPL measures and Cirrus and Spectralis temporal pRNFL thickness were estimated using latent class analysis.
Results: Eighty-one biopsies (24.2%) were considered positive for GCA. Clinical factors independently associated to TAB result by logistic regression analysis were temporal cutaneous hyperalgesia (OR=10.8; p < 0.001), jaw claudication (OR=4.6; p=0.001), recent-onset headache (OR=4.4; p=0.001), decreased temporal pulse (OR=2.8; p=0.02), pain and stiffness in neck and shoulders (OR=2.3; p=0.05), unintentional weight loss (OR=1.33; p=0.003) and age (OR=1.085; p=0.004). Other factors such as length of the surgical specimen (OR=1.079; p=0.028) and erythrocyte sedimentation rate (OR=1.042; p < 0.001) were also statistically significant.Overall, a moderate to good RNFL color-code agreement was found (0.435-0.884), except for the nasal quadrant. The temporal quadrant was the most abnormal color coding by both Cirrus (64.7%) and Spectralis (61.7%) in both the optic neuritis (ON) and non-ON group and by Stratus (58.8%) in the ON group. Abnormal temporal RNFL color-code rate was significantly higher in ON eyes than non-ON eyes by Cirrus (p < 0.001), Stratus (p < 0.001), and Spectralis (p=0.030). Globally, GCIPL measures were found to have higher sensitivity and specificity than temporal pRNFL measures. Average GCIPL thickness was found to be significantly more sensitive than temporal pRNFL by Cirrus (96.34% vs 58.41%; p < 0.05) and minimum GCIPL thickness was found to be significantly more sensitive than temporal pRNFL by Spectralis (96.41% vs 69.69%; p < 0.05).
Conclusions: TAB should be performed specially in older patients with GCA-compatible clinic. TAB could be avoided in patients with an isolated elevation of acute phase reactants, without GCA-compatible clinic.We found a substantial color-code disagreement among devices in patients with relapsing-remitting multiple sclerosis regarding the ON antecedent. In non-ON eyes, Spectralis yielded a significantly higher thinning for temporal quadrant than Cirrus. Average and minimum GCIPL measurements had significantly better sensitivity to detect retinal thickness changes in RRMS than temporal pRNFL thickness measured by Cirrus and Spectralis OCT, respectively.
