Purchase this article with an account.
Srilakshmi M. Sharma, Katharine Fallano, Neil R. Miller, Prem S. Subramanian; Development of Clinical Markers to Avoid Unnecessary Temporal Artery Biopsy in Giant Cell Arteritis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4887.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Giant cell arteritis (GCA) is a medium-to-large vessel vasculitis that, untreated, can cause blindness, myocardial infarction, and cerebral ischemia. Presentation may be highly non-specific, resulting in potentially morbid treatment with steroids and temporal artery biopsy (TAB). Depending on institution, only 10-30% of biopsies are positive for GCA. To identify clinical features correlating with negative biopsy in order to more accurately assess risk-benefit ratio of biopsy.
This is a retrospective review of all patients over age 50 undergoing a temporal artery biopsy at our institution from 2007-2009 with a minimum follow-up of four months. Keyword search identified 186 cases. 86 did not meet inclusion criteria; 100 cases were included in final analysis. The electronic records were reviewed for biopsy result, diagnosis at final follow-up, and a total of 41 variables within the history.
100 patients were analyzed (14 positive; 84 negative, of which 13 were diagnosed with GCA in follow-up; and 2 non-ocular GCA cases). The following combinations of any two clinical and laboratory features showed statistical significance using the Fishers exact test in differentiating true negative biopsy from positive cases: High ESR AND obesity, hyperlipidemia or history of renal disease( p=0.002, 0.007 and 0.009 respectively); anaemia AND a history of renal disease ( GFR<60); temporal headache AND hyperlipidemia or obesity ( 0.08 and 0.005) and hyperlipidaemia AND obesity ( p=0.009) with GFR<60 (p<0.001), obesity (p<0.001) and history of hyperlipidemia (p 0.009). We also identified two combinations of three clinical and laboratory features that showed statistical significance in differentiating true negative biopsy from positive cases: temporal headache associated with new neck pain/stiffness and hyperlipidaemia (0.006) and history of cardiovascular disease in association with hyperlipidemia and a high ESR (p=0.005).
Even after biopsy, deciding whether to treat for GCA may not be clear-cut. With this review we have identified a number of currently unreported features that may help distinguish patients likely to have truly negative TABs, potentially avoiding unnecessary biopsy and therapy. Future studies will assess the utility of an intermediate classification of pathological biopsy, in tandem with these newly identified clinical variables, in improving diagnostic accuracy.
This PDF is available to Subscribers Only