The 2016 revised ACR criteria for diagnosis of giant cell arteritis – Our case series: Can this avoid unnecessary temporal artery biopsies?

Sait, M; Lepore, Mario; Kwasnicki, Richard M.; Allington, Jonathan; Balasubramanian, Rajesh; Somasundaram, Santosh K.; Vashisht, Rajiv; Barkeji, Musa

doi:10.1016/j.ijso.2017.09.003

Cited by 35 publications

(47 citation statements)

References 14 publications

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“…Sait et al compared the functional utility of rACR criteria against the original ACR criteria and found that the more extensive rACR can serve as a more useful guide to reduce the number of unnecessary biopsies. [16] In case of TAB-positive results in the first and second five years, the odds ratio was approximately 2.7 (comparing second five years to the first five years), even though the P-value was borderline. The increase in the specimen length can be due to human factors.…”

Section: Main Finding and Conclusionmentioning

confidence: 96%

“…Based on the 2016 rACR criteria for the diagnosis of GCA, Sait et al proposed a simple management plan: (1) 2016 rACR scores ≤ 2 may not mandate a biopsy as these patients are very unlikely to have GCA; (2) patients with scores ≥ 5 will also not need TAB as they are likely to have GCA and should continue steroid therapy; and (3) a biopsy will be required in cases with scores of 3 and 4 because these patients have the most variability in TAB results. [16] However, further studies involving multiple centers with firm inclusion criteria should be performed before an algorithm that avoids biopsy in GCA management is applied. In our study, TAB-positive patients had a higher mean overall rACR score than the TAB-negative patients.…”

Section: Main Finding and Conclusionmentioning

confidence: 99%

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Temporal Artery Biopsy for Diagnosing Giant Cell Arteritis: A Ten-year Review

Aghdam

Sanjari

Manafi

et al. 2020

JOVR

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Purpose: To assess the use of temporal artery biopsy (TAB) in diagnosing giant cell arteritis (GCA) and to evaluate patients’ clinical and laboratory characteristics. Methods: We conducted a retrospective chart review of patients with suspected GCA who underwent TAB and had complete workup in a tertiary center in Iran between 2008 and 2017. The 2016 American College of Rheumatology (ACR) revised criteria for early diagnosis of GCA were used for each patient for inclusion in this study. Results: The mean age of the 114 patients in this study was 65.54 ± 10.17 years. The mean overall score according to the 2016 ACR revised criteria was 4.17 ± 1.39, with 5.82 ± 1.28 for positive biopsies and 3.88 ± 1.19 for negative biopsies (p <0.001). Seventeen patients (14.9%) had a positive biopsy. Although the mean post-fixation specimen length in the biopsy-positive group (18.35 ± 6.9 mm) was longer than that in the biopsy-negative group (15.62 ± 8.4 mm), the difference was not statistically significant (P = 0.21). There was no statistically significant difference between the groups in terms of sex, serum hemoglobin, platelet count, and erythrocyte sedimentation rate. There were statistically significant differences between the biopsy-negative and biopsy-positive groups with respect to patients’ age and C-reactive protein level (P < 001 and P = 0.012, respectively). Conclusion: The majority of TABs were negative. Reducing the number of redundant biopsies is necessary to decrease workload and use of medical services. We suggest that the diagnosis of GCA should be dependent on clinical suspicion.

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Section: Main Finding and Conclusionmentioning

confidence: 96%

Section: Main Finding and Conclusionmentioning

confidence: 99%

Temporal Artery Biopsy for Diagnosing Giant Cell Arteritis: A Ten-year Review

Aghdam

Sanjari

Manafi

et al. 2020

JOVR

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“…According to some studies and to 2016 revised ACR criteria, which proposed a clinical management tool using rACR scores, the temporal artery biopsy is not necessary if rACR ≥ 5 (7,8). In our case, we have a rACR score of 8 points, so this 71-year-old woman has a certain diagnosis of Horton's disease (9,10).…”

Section: Discussionmentioning

confidence: 73%

Horton’s disease in elderly women: still an overlooked diagnosis?

Cardoneanu¹,

Popescu²,

Burlui³

et al. 2019

Ro J Rheumatol.

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Introduction. Horton's disease is the most common form of vasculitis that occurs in patients older than 50 years. Due to its unusual clinical manifestation, the disease is often misdiagnosed and managed inappropriately. Early diagnosis and prompt initiation of treatment are essential to reduce the risk of severe neuro-ophthalmic complications. Case presentation. We present the case of a 71-year-old woman, with a family history of autoimmune disease, who complains of bilateral shoulder and pelvic girdle pain, low fever, jaw claudication and amaurosis fugax. After the initial tests that have been made in other departments, the patient has been diagnosed with iron deficiency anaemia and treated with iron tablets. Because of the lack of improvement in the clinical manifestations and unresponsive anaemia to oral iron treatment, the patient was admitted to our rheumatology department 5 months later. The anamnestic, clinical and paraclinical tests results along with the presence of the diagnosis criteria, allowed us to establish the Horton's disease diagnosis. The patient immediately received corticosteroid therapy having a prompt clinical and paraclinical response. Conclusion. Even if sometimes it can be hard to reach the diagnosis, every effort should be made to achieve it. The treatment should be started as soon as the clinical diagnosis has been made to prevent blindness and other potentially irreversible ischemic complications of Horton's disease.

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“…The demographic characteristics by diagnosis were consistent with known characteristic distributions for these types of vasculitis. For example, the ratios between female and male participants in this study were characteristic of each disease (25)(26)(27).…”

Section: Study Populationmentioning

confidence: 90%

Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis

et al. 2020

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Objective To assess the validity and clinical utility of the Brief Illness Perception Questionnaire (BIPQ) to measure illness perceptions in multiple forms of vasculitis. Methods Patients with giant cell arteritis (GCA), Takayasu’s arteritis (TAK), ANCA-associated vasculitis (AAV) and relapsing polychondritis (RP) were recruited into a prospective, observational cohort. Patients independently completed the BIPQ, Multidimensional Fatigue Inventory (MFI), SF-36 Health Survey (SF-36) and a Patient Global Assessment (PtGA) at successive study visits. Physicians concurrently completed a Physician Global Assessment (PhGA) form. Illness perceptions, as assessed by the BIPQ, were compared to responses from the full-length Revised Illness Perception Questionnaire (IPQ-R) and to other clinical outcome measures. Results 196 patients (GCA=47, TAK=47, RP=56, AAV=46) were evaluated over 454 visits. Illness perception scores in each domain were comparable between the BIPQ and IPQ-R (3.28 vs 3.47, p=0.22). Illness perceptions differed by type of vasculitis, with the highest perceived psychological burden of disease in RP. The BIPQ was significantly associated with all other patient-reported outcome measures (ρ=0.50-0.70, p<0.0001) but did not correlate with PhGA (ρ=0.13, p=0.13). A change in the BIPQ composite score of ≥7 over successive visits was associated with concomitant change in the PtGA. Change in the MFI and BIPQ scores significantly correlated over time (ρ= 0.38, p=0.0008). Conclusion The BIPQ is an accurate and valid assessment tool to measure and monitor illness perceptions in patients with vasculitis. Use of the BIPQ as an outcome measure in clinical trials may provide complimentary information to physician-based assessments.

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The 2016 revised ACR criteria for diagnosis of giant cell arteritis – Our case series: Can this avoid unnecessary temporal artery biopsies?

Cited by 35 publications

References 14 publications

Temporal Artery Biopsy for Diagnosing Giant Cell Arteritis: A Ten-year Review

Temporal Artery Biopsy for Diagnosing Giant Cell Arteritis: A Ten-year Review

Horton’s disease in elderly women: still an overlooked diagnosis?

Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis

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