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Sara J. Haug, Julie Schallhorn, Michael K. Yoon, Travis Porco, Stuart R. Seiff, Timothy J. McCulley; A National Survey of Practice Patterns: Effect of Prior Treatment with Corticosteroids on Diagnostic Capability of Temporal Artery Biopsies in Giant Cell Arteritis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5311.
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Temporal artery biopsy (TAB) remains the gold standard in establishing the diagnosis of giant cell arteritis (GCA). To ensure vision preservation, immunosuppressive therapy is often initiated prior to obtaining the TAB. The effect of pre-treatment with corticosteroids on the pathological diagnosis of GCA has been assessed by several investigators, with conflicting results. This study was designed to assess the current opinion within the ophthalmologic and rheumatologic communities of the effect of steroids on the diagnostic accuracy of TAB.
A survey was sent via e-mail using Survey Monkey (surveymonkey.com) to the members and affiliates of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), the North American Neuro-Ophthalmology Society (NANOS), and the American College of Rheumatology (ACR). Data analysis was performed using Wilcoxon rank sum test as appropriate.
Self described primary sub-specialty of the 644 respondents were as follows: oculoplastic surgery (n=129), neuro-ophthalmology (n=120), both oculoplastic surgery and neuro-ophthalmology (n=14), rheumatology (n=380) and other (n=6). Opinions varied greatly and were as follows: results are unreliable after 7 days (n=119, 20%), 10 days (n=98, 16%), 14 days (n=122, 20%) and greater than 14 days (n=255, 44%) after initiation of systemic steroids. More oculoplastic surgeons (n=33, 31%) felt a biopsy was unreliable after 7 days of steroid therapy than rheumatologists (n=73, 19%) and neuro-ophthalmologists (n=13, 12%, p<0.01, Wilcoxon rank sum test). In line with this trend, 54% of neuro-ophthalmologists and 43% of rheumatologists reported a biopsy was still reliable after 14 days of steroid treatment, whereas only 31% of oculoplastic surgeons felt the biopsy was reliable in the same time frame.
Opinion varied greatly regarding the accuracy of TAB in the diagnosis of GCA following initiation of systemic corticosteroid treatment. Overall, the trend among neuro-ophthalmologists and rheumatologists was that TABs remain accurate after 14 days of steroid therapy. No trend was seen among oculoplastic surgeons. This lack of consensus among all sub-specialties surveyed underscores the need for a systematic assessment of the effect of steroid treatment on histological features indicative of GCA.
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