scholarly journals Giant Cell (Temporal) Arteritis: The Rate and Clinical Predictors of Histopathological Diagnosis

2021 ◽  
Author(s):  
Ozlem Eski Yucel ◽  
Semih Murat Yucel ◽  
Seda Gun ◽  
Inci Gungor
Keyword(s):  
Giant Cell ◽  
Temporal Artery ◽  
Female Gender ◽  
Histopathological Diagnosis ◽  
Clinical Predictors ◽  
Laboratory Findings ◽  
Univariate Logistic Regression Analysis ◽  
Factors Affecting ◽  
Positive Group ◽  
Reactive Protein

Abstract Purpose To determine the rate of histopathological diagnosis by temporal artery (TA) biopsy (TAB) and the predictive clinical features of TAB positivity in patients with giant cell arteritis (GCA). Methods The records of patients who underwent TAB with pre-diagnosis of GCA between January 2006 and May 2020 were retrospectively reviewed. The demographic characteristics, symptoms, clinical and laboratory findings, TAB data, and the medications of the patients were recorded. The patients were divided into two groups as TAB-negative and TAB-positive, and compared clinically. Factors affecting TAB positivity were determined. Results TAB confirmed the diagnosis of GCA in 48% of our cases. The median fixed TAB specimen length was 1.7 (0.5–4.0) mm. TAB positivity increased with age (74 vs. 66 years, p = 0.027) and was more common in women (91.7% vs. 38.5%, p = 0.019). Jaw claudication (66.7% vs. 15.4%, p = 0.027) and decreased pulse of the TA (58.3% vs. 7.7%, p = 0.022) were more in the TAB-positive group than in the TAB-negative. The median C-reactive protein (CRP) level was statistically higher in the TAB-positive group compared to the TAB-negative (37 mg/L vs. 12.6 mg/L, p = 0.039). The univariate logistic regression analysis revealed female gender [OR (95%CI): 2.9 (1.7-181.3), p = 0.016], presence of jaw claudication [OR (95%CI): 2.4 (1.6–75.5), p = 0.015], decreased TA pulse [OR (95%CI): 2.8 (1.6-174.5), p = 0.018], and erythrocyte sedimentation rate (ESR) [OR (95%CI): 0.03 (1.0-1.1), p = 0.049] as factors associated with TAB positivity. Conclusion The rate of TAB positivity was 48%. Older age, female gender, the presence of jaw claudication and decreased pulse of TA, high ESR and CRP values are predictive features of TAB positivity and GCA diagnosis.

THU0309 UNILATERAL TEMPORAL ARTERY BIOPSY IS SUFFICIENT FOR DIAGNOSING GIANT CELL ARTERITIS IF THE SERUM C-REACTIVE PROTEIN LEVEL IS 10 MG/DL OR HIGHER

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 383-384
Author(s):  
T. Kise ◽  
E. Takamasu ◽  
Y. Miyoshi ◽  
N. Yokogawa ◽  
K. Shimada
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
High Dose ◽  
Temporal Artery Biopsy ◽  
C Reactive Protein ◽  
Positive Group ◽  
Reactive Protein ◽  
Discordance Rate ◽  
Serum Crp

Background:Temporal artery biopsy (TAB) is the gold standard for diagnosing giant cell arteritis (GCA). However, previous studies have reported that the discordance rate of TAB is 3-45%,i.e., in unliteral TAB, GCA may be overlooked in one in five patients, approximately. Evidence as to whether bilateral TAB should be performed initially or one-sided TAB is sufficient for diagnosing GCA is lacking.Objectives:To investigate the predictors of patients with GCA in whom one-sided TAB is sufficient.Methods:The present study was a cross-sectional, single center study conducted from April 1, 2011 to July 31, 2019 at Tokyo Metropolitan Tama Medical Center. Of all consecutive GCA cases for which bilateral TAB was performed, bilaterally positive cases and unilaterally positive cases were extracted as bilateral positive group (BPG) and unilateral positive group (UPG), respectively. GCA was defined in accordance with the classification criteria of the 1990 American College of Rheumatology, and GCA was diagnosed if no other etiology was found within six months after beginning of high-dose glucocorticoid treatment. Demographic, clinical and laboratory data were obtained from the medical records, and the BPG and the UPG were compared statistically in each variable. Statistical significance was defined asp< 0.05.Results:During study, 264 biopsies were performed for 145 cases, who suspected GCA and underwent TAB. The pathological positivity rate was 26.1% (68 / 264 biopsies). Of these, 53 cases had final diagnosis of GCA, in which 43 cases were biopsy proven GCA. Thirty-seven biopsy proven GCA with bilateral TAB were enrolled; 64.9% women; mean (SD) age 75 (8.9) years; median [IQR] TAB length 17.5 [13.0,20.0] mm; headache 54.1%; jaw claudication 45.9%; scalp tenderness 16.2%; temporal artery (TA) tenderness 32.4%; TA engorgement 32.4%; TA pulse abnormality 5.4%; visual symptoms 2.7%; a fever of 38.5°C or higher 40.5%; shoulder girdle pain 48.6%; imaging of aortitis or arteritis 40.5%; median [IQR] white blood cell 9,100 [7200, 12050] /μl; median [IQR] platelet cell 37.5 [27.0, 46.3] ×104/μl; median [IQR] C-reactive protein (CRP) 10.1 [3.9, 16.5] mg/dL; erythrocyte sedimentation rate [IQR] 105 [66, 129] mm/h. Thirty-one in 37 cases were positive bilaterally while 6 in 37 cases were positive unilaterally; and the discordance rate was 16.2%. The median sample length after formalin fixation was 19.0 mm for the BPG and 14.5 mm for the UPG (p= 0.171). The parameters above were compared between UPG and BPG. Of these, only the serum CRP value (mg/dL) differed statistically between groups, and the median value of the two groups was 10.6 and 6.5, respectively (median test:p= 0.031). To predict BPG, in whom unilateral TAB is sufficient for diagnosing GCA, the cut-off value of serum CRP with a specificity of 100% and a sensitivity of 61.3% was set at 9.3 mg/dL (ROC analysis: AUC 0.726).Conclusion:When the serum CRP level is 10 mg/dL or higher in GCA suspected patients, an unilateral TAB alone was sufficient for an accurate diagnosis.References:[1]Hellmich, B, et al.Ann Rheum Dis2020;79(1):19-30.[2]Breuer, GS, et al.J Rheumatol. 2009;36(4):794-796.[3]Czyz CN, et al.Vascular2019;27(4):347-351.[4]Durling B, et al.Can J Ophthalmol2014;49(2):157-161.Figure.Comparison of median CRP levels between unilaterally positive group and bilaterally positive group.Disclosure of Interests:None declared

scholarly journals Lyme carditis mimicking giant cell arteritis

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Krati Chauhan
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
Interesting Case ◽  
Temporal Artery Biopsy ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
System Disease ◽  
Lyme Carditis

Presenting an interesting case of a patient who complained of myalgias, fatigue, headache, jaw claudication and scalp tenderness. Patient’s physical examination was unremarkable. Laboratory findings showed elevated erythrocyte sedimentation rate and C-reactive protein, bilateral temporal artery biopsy results were negative and first degree atrioventricular block was seen on electrocardiogram. Serology for <em>Borrelia burgdorferi</em> was positive; patient was diagnosed with Lyme carditis and treated with doxycycline. Lyme is a tick-borne, multi-system disease and occasionally its presentation may mimic giant cell arteritis. On follow-up there was complete resolution of symptoms and electrocardiogram findings.

scholarly journals Novel ultrasonographic Halo Score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia

2020 ◽  
Vol 79 (3) ◽  
pp. 393-399 ◽  
Author(s):  
Kornelis S M van der Geest ◽  
Frances Borg ◽  
Abdul Kayani ◽  
Davy Paap ◽  
Prisca Gondo ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Clinical Diagnosis ◽  
Vascular Inflammation ◽  
Temporal Artery ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
A Prospective Study

ObjectivesUltrasound of temporal and axillary arteries may reveal vessel wall inflammation in patients with giant cell arteritis (GCA). We developed a ultrasound scoring system to quantify the extent of vascular inflammation and investigated its diagnostic accuracy and association with clinical factors in GCA.MethodsThis is a prospective study including 89 patients suspected of having GCA, of whom 58 had a confirmed clinical diagnosis of GCA after 6 months follow-up. All patients underwent bilateral ultrasound examination of the three temporal artery (TA) segments and axillary arteries, prior to TA biopsy. The extent of vascular inflammation was quantified by (1) counting the number of TA segments and axillary arteries with a halo and (2) calculating a composite Halo Score that also incorporated the thickness of each halo.ResultsHalo counts and Halo Scores showed moderate diagnostic accuracy for a clinical diagnosis of GCA. They correlated positively with systemic inflammation. When compared with the halo count, the Halo Score correlated better with C-reactive protein (CRP) levels and allowed to firmly establish the diagnosis of GCA in more patients. Higher halo counts and Halo Scores were associated with a higher risk of ocular ischaemia. They allowed to identify subgroups of patients with low risk (≤5%) and high risk of ocular ischaemia (>30%).ConclusionsUltrasound halo scoring allows to quantify the extent of vascular inflammation in GCA. Extensive vascular inflammation on ultrasound may provide strong diagnostic confirmation and associates with ocular ischaemia in GCA.

scholarly journals Visual Complications in Patients with Biopsy-proven Giant Cell Arteritis: A Population-based Study

2016 ◽  
Vol 43 (8) ◽  
pp. 1559-1565 ◽  
Author(s):  
Muna Saleh ◽  
Carl Turesson ◽  
Martin Englund ◽  
Peter A. Merkel ◽  
Aladdin J. Mohammad
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Inflammatory Responses ◽  
Temporal Artery ◽  
Reference Population ◽  
Population Based ◽  
Population Based Study ◽  
Protein Levels ◽  
Reactive Protein ◽  
Background Population

Objective.To study the clinical and laboratory characteristics of patients with biopsy-proven giant cell arteritis (GCA) with visual complications, and to evaluate the incidence rate of visual complications in GCA compared to the background population.Methods.Data from 840 patients with GCA in the county of Skåne, Sweden, diagnosed between 1997 and 2010, were used for this analysis. Cases with visual complications were identified from a diagnosis registry and confirmed by a review of medical records. The rate of visual complications in patients with GCA was compared with an age- and sex-matched reference population.Results.There were 85 patients (10%) who developed ≥ 1 visual complication after the onset of GCA. Of the patients, 18 (21%) developed unilateral or bilateral complete visual loss. The mean age at diagnosis was 78 years (± 7.3); 69% were women. Compared with patients without visual complications, those with visual complication had lower C-reactive protein levels at diagnosis and were less likely to have headache, fever, and palpable abnormal temporal artery. The use of β-adrenergic inhibitors was associated with visual complications. The incidence of visual complications among patients with GCA was 20.9/1000 person-years of followup compared to 6.9/1000 person-years in the reference population, resulting in a rate ratio of 3.0 (95% CI 2.3–3.8).Conclusion.Ten percent of patients with GCA developed visual complications, a rate substantially higher than that of the general population. Patients with GCA who had visual complications had lower inflammatory responses and were more likely to have been treated with β-adrenergic inhibitors compared with patients without visual complications.

Baseline clinical predictors of an ultimate giant cell arteritis diagnosis in patients referred to temporal artery biopsy

2016 ◽  
Vol 35 (7) ◽  
pp. 1817-1822 ◽  
Author(s):  
Chagai Grossman ◽  
Iris Barshack ◽  
Nira Koren-Morag ◽  
Ilan Ben-Zvi ◽  
Gil Bornstein
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
Temporal Artery Biopsy ◽  
Clinical Predictors

scholarly journals P206 Rethinking old biomarkers: novel predictors of giant cell arteritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Tamas Somoskeoy ◽  
Alexandra Bourn ◽  
Sally Knights ◽  
Ben Mulhearn
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Clinical Judgment ◽  
Vision Loss ◽  
Temporal Artery ◽  
Temporal Artery Biopsy ◽  
Rapid Reduction ◽  
Laboratory Findings ◽  
Individual Parameter ◽  
Predictive Values

Abstract Background/Aims  Giant cell arteritis (GCA) is a large vessel vasculitis mainly affecting the arteries of the head and neck which, if untreated, may lead to permanent vision loss. Glucocorticoids are highly effective at turning off inflammation but come with toxic side effects, making prompt diagnosis essential. There is no gold-standard investigation for GCA. Although specific, temporal artery biopsy (TAB) is only positive in approximately 25% of cases making it problematic as a rule-in diagnostic test. Vascular ultrasound may aid diagnosis but there is a rapid reduction in sensitivity with glucocorticoid use and it is not yet universally available. Diagnosis therefore requires the integration of clinical judgment with blood tests measuring inflammation, imaging, and biopsy. Aims:Identify which components of the history, examination and laboratory findings are most predictive of a positive diagnosis of GCA in the local region of Yeovil District Hospital, and to investigate the usefulness of alternative blood biomarkers. Methods  Data was collected from GCA clinic attendances between August 2018 and February 2020 using electronic notes, clinic letters and the pathology system. Predictive values, sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated for each individual parameter and for groups of parameters. Results  Ninety-one patients presented to GCA clinic in the 18 months studied. Median age was 71 and 73% were female. 56 patients with suspected disease went on to have TAB, of which 38/56 (68%) were of adequate length ( &gt; =10mm), and of those, 12/38 (32%) confirmed a diagnosis of GCA. 43/91 (47%) patients were ultimately diagnosed biopsy proven or suspected GCA. Headache was the most common presenting feature (88%) followed by raised ESR (55%), raised CRP (53%), visual disturbance (44%), scalp tenderness (33%), jaw claudication (31%), PMR symptoms (27%) and temporal artery abnormalities (20%). Headache and raised CRP+/-ESR were the most sensitive markers (91% and 100%, respectively). They were, however, the least specific (4% and 36%). Temporal artery abnormality was the most specific finding (81%). ROC analysis revealed that the best-performing biomarkers were monocytes (area under the ROC curve (AUC) of 0.81) and platelets (AUC 0.80), which were superior to jaw claudication, the best-performing classical biomarker (AUC 0.68). Platelets above 450 x 109/L had a specificity of 96% with a likelihood ratio of 10.9. Monocytes above 0.45 x 106/L had sensitivity and specificity of 100% and 67%, respectively. Conclusion  GCA cannot be accurately predicted by any single feature. In this cohort, absence of headache with a normal CRP+/-ESR ruled out GCA. Platelets and monocytes performed better than all the classical parameters associated with GCA. Validation of these biomarkers in a larger cohort is now needed to ascertain cut-off points which may help to develop a more accurate method to predict cases of GCA. Disclosure  T. Somoskeoy: None. A. Bourn: None. S. Knights: None. B. Mulhearn: None.

Evaluation for Clinical Predictors of Positive Temporal Artery Biopsy in Giant Cell Arteritis

2011 ◽  
Vol 69 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Kevin L. Rieck ◽  
Tanaz A. Kermani ◽  
Kristine M. Thomsen ◽  
William S. Harmsen ◽  
Matthew J. Karban ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
Temporal Artery Biopsy ◽  
Clinical Predictors
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