Temporal Artery Biopsy is not Required in all Cases of Suspected Giant Cell Arteritis
ABSTRACT Temporal artery biopsy (TAB) is performed during the diagnostic workup for giant cell arteritis (GCA), a vasculitis with the potential to cause irreversible blindness or stroke. However, treatment is often started on clinical grounds, and TAB result frequently does not influence patient management. The aim of this study was to assess the need for TAB in cases of suspected GCA.
We performed a retrospective review of 185 TABs performed in our institution from 1990 to 2010. Patients were identified through the Hospital In-Patient Enquiry database and theater records. Clinical findings, erythrocyte sedimentation rate, steroid treatment preoperatively, American College of Rheumatology (ACR) criteria for GCA score, biopsy result, and follow-up were recorded.
Fifty-eight (31.4%) biopsies were positive for GCA. Presence of jaw claudication (P = 0.001), abnormal fundoscopy (P = 0.001), and raised erythrocyte sedimentation rate (P = 0.001) were significantly associated with GCA. The strongest association with positive biopsy was seen with the prebiopsy ACR score (P < 0.001). Twenty-four (13.7%) patients had undergone biopsy, despite no potential for meeting ACR criteria preoperatively. None of these were positive. Overall, 29 (16.4%) patients had management altered by TAB result.
Our results confirm that TAB does not affect management in the majority of patients with suspected GCA. We conclude that TAB has benefit only for patients who score 2 or 3 on the ACR criteria for GCA without biopsy.
SourceAvailable from: sciencedirect.com[Show abstract] [Hide abstract]
ABSTRACT: In the differential diagnostic process for rheumatic inflammatory and/or connective tissue diseases (CTDs), history taking and physical examination are of main importance, more than additional investigations, as many diagnoses are clinical diagnoses with specific clinical/patterns and gold standards are often lacking. In rheumatic diseases and, especially, CTD, many organ systems apart from the joints may be involved. These include the skin and underlying tissues, muscles, salivary glands, nerves, kidneys and blood vessels. Biopsy specimens of these tissues may be helpful in establishing a diagnosis, in assessing the extent and severity of organ involvement and sometimes in monitoring therapy. In this chapter, practical information is described regarding which clinical practice might indicate a need for biopsy, and on how to prepare the patient, how to perform the biopsy and handle the biopsy specimen. In addition, the limitations and complications one should be cautious of are described. For full details of the clinical spectrum of the diseases and the histopathology, the reader is kindly referred to relevant textbooks.Best practice & research. Clinical rheumatology 04/2013; 27(2):209-36. DOI:10.1016/j.berh.2013.03.002 · 3.06 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: We report a case of a 73-year-old woman with a brainstem stroke presenting as Wallenberg syndrome. By transoesophageal echocardiography and combined 18F-fluordeoxyglucose positron emission and CT (18F-FDG PET/CT), the diagnosis of large artery vasculitis owing to giant cell arteritis was confirmed. In the absence of classical clinical signs, the examination of the large extracranial vessels by ultrasound and 18F-FDG PET/CT played the key role in detecting a widespread vasculitis.Case Reports 03/2013; 2013. DOI:10.1136/bcr-2012-006994
[Show abstract] [Hide abstract]
ABSTRACT: Thromboangiitis obliterans, or Buerger disease, is a chronic nonatherosclerotic endarteritis manifesting as inflammation and thrombosis of distal extremity small and medium-sized arteries resulting in relapsing episodes of distal extremity ischemia. Takayasu arteritis is a rare syndrome characterized by inflammation of the aortic arch, pulmonary, coronary, and cerebral vessels, presenting with cerebrovascular symptoms, myocardial ischemia, or upper extremity claudication in young, often female, patients. Kawasaki disease is a small- and medium-vessel acute systemic vasculitis of young children, with morbidity and mortality stemming from coronary artery aneurysms. Microscopic polyangiitis, Churg-Strauss syndrome, and Wegener granulomatosis are systemic small-vessel vasculitides, affecting arterioles, capillary beds and venules, and each presenting with variable effects on the pulmonary, renal and gastrointestinal systems.Surgical Clinics of North America 08/2013; 93(4):833-75. DOI:10.1016/j.suc.2013.04.003 · 1.93 Impact Factor