Clinical correlation of biopsy results in patients with temporal arteritis

Abstract

Objective: Temporal arteritis is systemic vasculitis of medium and large sized vessels. The lowest incidence rates were reported in Turkey, Japan and Israel. We aimed to investigate the results of patients with biopsy-proven temporal arteritis and those classified according to the American College of Rheumatology criteria from a low-incidence region for temporal arteritis. The results of our study are noteworthy, since there is limited data on pathologic diagnosis of temporal arteritis in Turkey. Method:We studied the medical records, laboratory findings such as erythrocyte sedimentation rate and C-reactive protein levels, biopsy results, and postoperative complications of all the patients operated for temporal artery biopsy at our clinic. We used the computerized laboratory registry that keeps all records of 42 consecutive temporal artery biopsy results from January 2011 to December 2016. Results: The mean age was 66±12.5 years. The most common manifestations on admission were temporal headache, optic neuritis and jaw claudication, respectively. Temporal artery biopsy results confirmed tempoal arteritis in eight out of 42 (19%) patients. There was no statistically significant difference between biopsy-positive and biopsy-negative groups in terms of sex, age, erythrocyte sedimentation rate, C-reactive protein and biopsy length. Conclusion: We were not able to find a correlation between the analysis of biopsy results and clinical evaluation of patients with temporal arteritis. We suggest that diagnosis of temporal arteritis depends on clinical suspicion. Laboratory examination results may not be helpful in accurate diagnosis of tempoal arteritis.

2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis

“…Therefore, temporal artery biopsy remains the optimal approach to diagnosing GCA in the US, because ultrasound is operatordependent and results are influenced by treatment (i.e., signs of inflammation quickly disappear with glucocorticoid treatment). In centers with appropriate training and expertise in using temporal artery ultrasound, ultrasound may be a useful and complementary tool for diagnosing GCA (29)(30)(31)(32)(33).…”

2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis

“…Therefore, temporal artery biopsy remains the optimal approach to diagnosing GCA in the US, because ultrasound is operator‐dependent and results are influenced by treatment (i.e., signs of inflammation quickly disappear with glucocorticoid treatment). In centers with appropriate training and expertise in using temporal artery ultrasound, ultrasound may be a useful and complementary tool for diagnosing GCA (29–33).…”

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“…El 40% de los pacientes en nuestro estudio presentaron CM, que es un síntoma isquémico de fatiga o dolor con la masticación que se debe al estrechamiento u obstruc-ción de ramas faciales de la carótida externa (que irrigan los músculos de la masticación) y está presente en el 45% de los pacientes con ACG. La CM se vio en el 54% de los pacientes que tuvieron biopsia positiva en contraste con un 3% de biopsia negativa (p<0.001) [29][30][31] .…”

“…Otras causas menos comunes de CM son la amiloidosis primaria, la poliarteritis nodosa (PAN), el síndrome de Churg-Strauss (SCS), la arteritis de Takayasu (AT), la granulomatosis con poliangeítis (GPA), la leucemia de células vellosas, la enfermedad de MacArdle, la crioglobulinemia asociada a vasculitis y la aterosclerosis carotídea [30][31][32] . Para aumentar la complejidad del tema, la ACG puede afectar el riñón y el pulmón al igual que la GPA 32,33 .…”