Top

01-03-2016 | Vasculitis | Article

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

Journal: Clinical Rheumatology

Authors: Chagai Grossman, Iris Barshack, Nira Koren-Morag, Ilan Ben-Zvi, Gil Bornstein

Publisher: Springer London

Abstract

The diagnosis of giant cell arteritis (GCA) is based on clinical grounds and confirmed by characteristic histological findings on temporal artery biopsy (TAB). Patients may be diagnosed with GCA based on clinical grounds only, despite negative histological findings. We aimed to investigate which baseline clinical and laboratory features best predict an ultimate diagnosis of giant cell arteritis among patients referred to TAB. We retrospectively analyzed 224 patients who underwent TAB in our hospital between 2000 and 2014. Patients were diagnosed with GCA if TAB was positive for GCA, or by clinical grounds only despite a negative biopsy, provided they fulfilled the American College of Rheumatology 1990 criteria. Baseline clinical and laboratory features were obtained from medical records. Predictors of an ultimate GCA diagnosis were investigated. Overall, 82 patients were diagnosed with GCA—57 had histological evidence of GCA and 25 were diagnosed with GCA despite a negative biopsy. One hundred and forty-two patients were not diagnosed with GCA. Predictors of an eventual diagnosis of GCA in a multivariate logistic regression analysis were headache (OR = 6; p < 0.001), jaw claudication (OR 4.5; p = 0.007), erythrocyte sedimentation rate (ESR) (OR = 1.5; p = 0.032) and platelet count (OR = 1.74; p = 0.004). Among patients referred to TAB, headache, jaw claudication, ESR, and thrombocyte levels are predictors for an ultimate diagnosis of GCA. These clinical and laboratory features should be considered when contemplating the diagnosis and treatment of GCA.

Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ, Miranda-Filloy JA, Gonzalez-Juanatey C, Martin J, Llorca J (2009) Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum 61:1454–1461CrossRefPubMed

Healey LA, Wilske KR (1977) Manifestations of giant cell arteritis. Med Clin North Am 61:261–270CrossRefPubMed

Nordborg E, Nordborg C, Malmvall BE, Andersson R, Bengtsson BA (1995) Giant cell arteritis. Rheum Dis Clin North Am 21:1013–1026PubMed

Nesher G (2014) The diagnosis and classification of giant cell arteritis. J Autoimmun 48–49:73–75CrossRefPubMed

Muratore F, Pazzola G, Pipitone N, Boiardi L, Salvarani C (2014) Large-vessel involvement in giant cell arteritis and polymyalgia rheumatica. Clin Exp Rheumatol 32(82):S106–111, 2014PubMed

Gonzalez-Gay MA, Barros S, Lopez-Diaz MJ, Garcia-Porrua C, Sanchez-Andrade A, Llorca J (2005) Giant cell arteritis: disease patterns of clinical presentation in a series of 240 patients. Medicine (Baltimore) 84:269–276CrossRef

Hall S, Persellin S, Lie JT, O’Brien PC, Kurland LT, Hunder GG (1983) The therapeutic impact of temporal artery biopsy. Lancet 2:1217–1220CrossRefPubMed

Gonzalez-Gay MA (2005) The diagnosis and management of patients with giant cell arteritis. J Rheumatol 32:1186–1188PubMed

Hauser WA, Ferguson RH, Holley KE, Kurland LT (1971) Temporal arteritis in Rochester, Minnesota, 1951 to 1967. Mayo Clin Proc 46:597–602PubMed

10.

Roth AM, Milsow L, Keltner JL (1984) The ultimate diagnoses of patients undergoing temporal artery biopsies. Arch Ophthalmol 10:901–903CrossRef

11.

Salvarani C, Macchioni P, Zizzi F, Mantovani W, Rossi F, Castri C, Capozzoli N, Baricchi R, Boiardi L, Chiaravalloti F et al (1991) Epidemiologic and immunogenetic aspects of polymyalgia rheumatica and giant cell arteritis in northern Italy. Arthritis Rheum 34:351–356CrossRefPubMed

12.

Gonzalez-Gay MA, Garcia-Porrua C, Llorca J, Gonzalez-Louzao C, Rodriguez-Ledo P (2001) Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy. Semin Arthritis Rheum 30:249–256CrossRefPubMed

13.

Breuer GS, Nesher R, Nesher G (2008) Negative temporal artery biopsies: eventual diagnoses and features of patients with biopsy-negative giant cell arteritis compared to patients without arteritis. Clin Exp Rheumatol 26:1103–1106PubMed

14.

Hunder GG, Arend WP, Bloch DA, Calabrese LH, Fauci AS, Fries JF, Leavitt RY, Lie JT, Lightfoot RW Jr, Masi AT et al (1990) The American College of Rheumatology 1990 criteria for the classification of vasculitis. Introduction. Arthritis Rheum 33:1065–1067CrossRefPubMed

15.

Murchison AP, Gilbert ME, Bilyk JR, Eagle RC Jr, Pueyo V, Sergott RC, Savino PJ (2012) Validity of the American College of Rheumatology criteria for the diagnosis of giant cell arteritis. Am J Ophthalmol 154:722–729CrossRefPubMed

16.

Hunder GG (1998) The use and misuse of classification and diagnostic criteria for complex diseases. Ann Intern Med 129:417–418, 1998CrossRefPubMed

17.

Lenton J, Donnelly R, Nash JR (2006) Does temporal artery biopsy influence the management of temporal arteritis? QJM 99:33–36CrossRefPubMed

18.

Davies C, Frost B, Eshan O, McLain AD, Shandall A (2006) Temporal artery biopsy…who needs one? Postgrad Med J 82:476–478CrossRefPubMedPubMedCentral

19.

Varma D, O’Neill D (2004) Quantification of the role of temporal artery biopsy in diagnosing clinically suspected giant cell arteritis. Eye (Lond) 18:384–388CrossRef

20.

Quinn EM, Kearney DE, Kelly J, Keohane C, Redmond HP (2012) Temporal artery biopsy is not required in all cases of suspected giant cell arteritis. Ann Vasc Surg 26:649–654CrossRefPubMed

21.

Gonzalez-Lopez JJ, Gonzalez-Moraleja J, Burdaspal-Moratilla A, Rebolleda G, Nunez-Gomez-Alvarez MT, Munoz-Negrete FJ (2013) Factors associated to temporal artery biopsy result in suspects of giant cell arteritis: a retrospective, multicenter, case-control study. Acta Ophthalmol 91:763–768CrossRefPubMed

22.

Rieck KL, Kermani TA, Thomsen KM, Harmsen WS, Karban MJ, Warrington KJ (2011) Evaluation for clinical predictors of positive temporal artery biopsy in giant cell arteritis. J Oral Maxillofac Surg 69:36–40CrossRefPubMed

23.

Chmelewski WL, McKnight KM, Agudelo CA, Wise CM (1992) Presenting features and outcomes in patients undergoing temporal artery biopsy. A review of 98 patients. Arch Intern Med 152:1690–1695, 1992CrossRefPubMed

24.

Walvick MD, Walvick MP (2011) Giant cell arteritis: laboratory predictors of a positive temporal artery biopsy. Ophthalmology 118:1201–1204CrossRefPubMed

25.

Duhaut P, Pinede L, Bornet H, Demolombe-Rague S, Dumontet C, Ninet J, Loire R, Pasquier J (1999) Biopsy proven and biopsy negative temporal arteritis: differences in clinical spectrum at the onset of the disease. Groupe de Recherche sur l’Arterite a Cellules Geantes. Ann Rheum Dis 58:335–341CrossRefPubMedPubMedCentral

26.

Lie JT (1990) Illustrated histopathologic classification criteria for selected vasculitis syndromes. American College of Rheumatology Subcommittee on Classification of Vasculitis. Arthritis Rheum 33:1074–1087CrossRefPubMed

27.

Taylor-Gjevre R, Vo M, Shukla D, Resch L (2005) Temporal artery biopsy for giant cell arteritis. J Rheumatol 32:1279–1282PubMed

Medicine Matters Rheumatology

Abstract