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R. A. Walker, R. B. Hall, R. D. Pekush, R. M. Taylor-Gjevre; An Evaluation of the Influence of Temporal Artery Biopsy Result on Subsequent Corticosteroid Use. Invest. Ophthalmol. Vis. Sci. 2008;49(13):6006.
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The purpose of this study was to evaluate a subset of patients who underwent temporal artery biopsies (TABs) and how this biopsy determined subsequent corticosteroid use secondary to a diagnosis of giant cell arteritis (GCA). Additionally we were interested in determining if patients treated with long-term steroids were appropriately prophylaxed for osteoporosis.
A retrospective chart review of patients who received TABs between January 1995 and March 2005 for a suspected diagnosis of GCA was undertaken. Data was extracted from the charts and included clinical presentation, biopsy result, duration and dosage of steroid therapy, whether or not the patient received osteoporosis prevention, and clinical course descriptors.
130 TABs were performed on 115 patients. Of these, 23 of the biopsies (17.7%) were reported as positive. 15 patients had a repeated biopsy and 3 of these were reported as positive (20.0%). 29 patients were given a diagnosis of GCA. Corticosteroid therapy was commenced pre-biopsy in 89 of the 115 patients (77.3%) but continued in only 6 patients without positive biopsies. Of these patients, one had a strong clinical suspicion of GCA, but no artery was isolated in the biopsy, two had ‘indeterminant’ biopsy results and a history of PMR, and three had negative biopsy reports. Of the three with negative biopsy reports, one was felt to have "healed arteritis" as a result of long-term prednisone therapy and another had a history of PMR. The average duration of corticosteroid therapy was 47.4 weeks (standard deviation = 25.8 weeks) with a range of 16 weeks to 118 weeks. Only 18 of the 29 patients were treated with bisphosphonates for osteoporosis prevention during the ophthalmology follow-up time, only once appearing to be suggested by the ophthalmologist.
In our facility, the temporal artery biopsy was virtually the sole determinant in treating for temporal arteritis. A second temporal artery biopsy was only attempted in those who had a very convincing clinical picture of GCA, and even in these patients if the biopsy was negative, the patient was diagnosed as GCA negative unless there was a history of PMR or a suspicion of "healed arteritis". Only one GCA patient was recommended osteoporosis prophylaxis by the ophthalmologist, suggesting that more awareness is needed within the ophthalmology community regarding the importance of osteoporosis prevention in patients receiving long-term steroid therapy.
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