I read with interest the study by González Porto et al. who question the usefulness of ultrasound in the diagnosis of giant cell arteritis (GCA).1 The article reflects an effort made to improve precision and innovation in the diagnosis of this disease which is to be welcomed, although several inaccuracies would need to be touched on.

In material and methods the experience of the sonographer is not mentioned, although this is vital for evaluation of findings. It should thus be highlighted that the sonographic parameters used are not optimum, because a 10MHz probe was used whilst in the EULAR2 recommendations it states that for temporal arteries a probe of at least 15MHz should be used; the frequency of colour used is very low, 5.7MHz compared with 7–12MHz which should be used and the PRF of 1.1kHz should have been 2–3.5kHz. This would all probably reduce the quality of the results and challenge the final conclusion that the usefulness of the ultrasound was limited.

In the EULAR recommendations on the use of imaging in large cell vasculitis (LCV) it is stated that ultrasound should be performed by a specialist trained in using the equipment, operational procedures and appropriate adjustments. They also comment upon the fact that reliability can improve with specific training and that scientific societies need to promote training programmes, particularly in LCV sonography. I know that the Spanish Rheumatology Society had a training programme for implementation of these recommendations during the first quarter of 2019 and I imagine that this initiative will also be adopted by other scientific societies.

However, I wish to offer my thanks and underline the authors’ interest in bringing this technique to their patients. Also to encourage them to continue, in the secure knowledge that it will be useful for them. This is the path we began in 2004 and our results then were only 15% higher than those of the authors, with sensitivities and specificities of approximately 70%. Since then we periodically review our results comparing the diagnostic classification in keeping with the biopsy, ACR classification criteria and ultrasound criteria. This, together with improvement in the quality of the equipment, have led to a sensitivity of 91.6% and specificity of 95.83%3 in our centre.

I would finally like to point out that the debate on whether to use ultrasound or biopsy in GCA diagnosis is coming to an end. EULAR recommendations conclude that both are valid and their use depends on their availability and the training practised in each centre.2 In the next GCA ACR/EULAR classification criteria, presented in the last ACR 2018 Congress, ultrasound appears to be of the same value (5 points) as biopsy, with 6 points being the number required to confirm classification after fulfilling entry criteria.