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S. Heinzelmann, D. Boehringer, C. Auw-Hädrich, T. Neß; Relevance of Clinical Parameters for Diagnosis of Giant Cell Arteritis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):817.
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Giant cell arteritis (GCA) is the most frequent generalized vasculitis in the elderly. It is the main cause of arteritic anterior ischemic optic neuropathy (AAION) in contrast to nonarteritic AION (NAION). GCA affects medium to large sized arteries. We were interested in clinical and laboratory parameters to predict a positive biopsy result in presumed GCA.
The data of 205 patients who underwent temporal artery biopsy at the University Eye Hospital Freiburg between 1993 and 2007 were analyzed. A number of clinical and laboratory parameters were obtained: erythrocyte sedimentation rate (ESR), fibrinogen, C-reactive protein (CRP), new onset of headache, jaw claudication, myalgia, weight loss, ocular involvement, fever, fulfilled American College of Rheumatology (ACR) criteria. The positive predictive value of these parameters was calculated.
114 samples showed typical histology for GCA while 91 specimens exhibited no signs of inflammation. There was no statistical significant difference between the two groups in age, gender, fever, weight loss, and central artery occlusion. In contrast, new onset of headache, jaw claudication, AAION, CRP, ESR, fibrinogen, and fulfilled ACR criteria differed highly significant between patients with positive and negative histology, respectively. Using a linear discriminant analysis, a positive predictive value of 90% was calculated.
The clinical parameters jaw claudication, AAION, and inflammatory laboratory values are good predictors for a positive result of temporal artery biopsy in presumed GCA. Therefore they represent good indicators for the diagnosis of the disease.
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