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Predictive value of positive temporal artery biopsies in patients with clinically suspected giant cell arteritis considering temporal artery ultrasound findings

  • Falk SommerEmail author
  • Eberhard Spörl
  • Robert Herber
  • Lutz E. Pillunat
  • Naim Terai
Inflammatory Disorders
  • 17 Downloads

Abstract

Purpose

To investigate the impact of ocular symptom, non-ocular symptom, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and temporal artery ultrasound (TAU) findings on the predictive value of a positive temporal artery biopsy (TAB) in patients with clinically suspected giant cell arteritis (GCA).

Methods

In a retrospective, interventional study, data from 68 patients with clinically suspected GCA who underwent TAB between 2015 and 2017 were analysed. Analysis included five parameters: ocular symptom, non-ocular symptom, ESR, CRP level and TAU findings. Using a contingency table, each parameter was separately analysed for the predictive value of a positive TAB, and a discriminant analysis was applied to check for the predictive value of a positive TAB under consideration of all five parameters and of the three strongest predictive parameters.

Results

A positive TAB was significantly associated with a positive TAU in 15 of 15 patients (p < 0.001), an increased ESR in 37 of 53 patients (p < 0.001), an increased CRP level in 35 of 56 patients (p = 0.004) and non-ocular symptoms in 27 of 40 patients (p = 0.01). A positive TAB was not significantly associated with the presence of ocular symptoms (25 of 46 patients, p = 0.988). Using a discriminant analysis, the combined parameters TAU, ESR and CRP were able to predict a positive TAB in 97.3% of all patients. The positive predictive value was 78.3%, and the negative predictive value was 95.4%.

Conclusion

Temporal artery biopsy to confirm the diagnosis of GCA may not be mandatory in patients who show an elevated ESR and CRP level and a positive TAU.

Keywords

Giant cell arteritis Temporal artery biopsy Erythrocyte sedimentation rate C-reactive protein Temporal artery ultrasound 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study (retrospective study), formal consent was not required.

References

  1. 1.
    Nesher G (2014) The diagnosis and classification of giant cell arteritis. J Autoimmun 48-49:73–75CrossRefGoogle Scholar
  2. 2.
    Buttgereit F, Dejaco C, Matteson EL, Dasgupta B (2016) Polymyalgia rheumatica and giant cell arteritis: a systematic review. JAMA 315:2442–2458CrossRefGoogle Scholar
  3. 3.
    Weyand CM, Goronzy JJ (2014) Giant-cell arteritis and polymyalgia rheumatica. N Engl J Med 371:50–57CrossRefGoogle Scholar
  4. 4.
    Borchers AT, Gershwin ME (2012) Giant cell arteritis: a review of classification, pathophysiology, geoepidemiology and treatment. Autoimmun Rev 11:A544e54CrossRefGoogle Scholar
  5. 5.
    Hunder GG, Bloch DA, Michel BA et al (1990) The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 33:1122–1128CrossRefGoogle Scholar
  6. 6.
    Ball EL, Walsh SR, Tang TY et al (2010) Role of ultrasonography in the diagnosis of temporal arteritis. Br J Surg 97:1765–1771CrossRefGoogle Scholar
  7. 7.
    Suelves AM, España-Gregori E, Tembl J et al (2010) Doppler ultrasound and giant cell arteritis. Clin Ophthalmol 25:1383–1384CrossRefGoogle Scholar
  8. 8.
    Le K, Bools LM, Lynn AB et al (2015) The effect of temporal artery biopsy on the treatment of temporal arteritis. Am J Surg 209:338–341CrossRefGoogle Scholar
  9. 9.
    Saedon H, Saedon M, Goodyear S et al (2012) Temporal artery biopsy for giant cell arteritis: retrospective audit. JRSM Short Rep 3:73CrossRefGoogle Scholar
  10. 10.
    De Smit E, O’Sullivan E, Mackey DA, Hewitt AW (2016) Giant cell arteritis: ophthalmic manifestations of a non-ocular symptoms disease. Graefes Arch Clin Exp Ophthalmol 254:2291–2306CrossRefGoogle Scholar
  11. 11.
    Kermani TA, Schmidt J, Crowson CS et al (2012) Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Semin Arthritis Rheum 41:866–871CrossRefGoogle Scholar
  12. 12.
    Dasgupta B, Borg FA, Hassan N et al (2010) BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology 49:1594–1597CrossRefGoogle Scholar
  13. 13.
    Stacy RC, Gilbert AL, Rizzo JF 3rd (2015) Correlation of clinical profile and specific histopathological features of temporal artery biopsies. J Neuroophthalmol 35:127–133Google Scholar
  14. 14.
    Grossman C, Ben-Zvi I, Barshack I, Bornstein G (2017) Association between specimen length and diagnostic yield of temporal artery biopsy. Scand J Rheumatol 46:222–225CrossRefGoogle Scholar
  15. 15.
    Bowling K, Rait J, Atkinson J, Srinivas G (2017) Temporal artery biopsy in the diagnosis of giant cell arteritis: does the end justify the means? Ann Med Surg (Lond) 20:1–5CrossRefGoogle Scholar
  16. 16.
    Ninan J, Lester S, Hill C (2016) Giant cell arteritis. Best Pract Res Clin Rheumatol 30:169–188CrossRefGoogle Scholar
  17. 17.
    Muratore F, Boiardi L, Restuccia G et al (2013) Comparison between colour duplex sonography findings and different histological patterns of temporal artery. Rheumatology (Oxford) 52:2268–2274CrossRefGoogle Scholar
  18. 18.
    Black R, Roach D, Rischmueller M et al (2013) The use of temporal artery ultrasound in the diagnosis of giant cell arteritis in routine practice. Int J Rheum Dis 16:352–357CrossRefGoogle Scholar
  19. 19.
    Luqmani R, Lee E, Singh S et al (2016) The role of ultrasound compared to biopsy of temporal arteries in the diagnosis and treatment of giant cell arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study. Health Technol Assess 20:1–238CrossRefGoogle Scholar
  20. 20.
    Bottinger LE, Svedberg CA (1967) Normal erythrocyte sedimentation rate and age. Br Med J 2:85–87CrossRefGoogle Scholar
  21. 21.
    Grossman C, Barshack I, Koren-Morag N et al (2016) Baseline clinical predictors of an ultimate giant cell arteritis diagnosis in patients referred to temporal artery biopsy. Clin Rheumatol 35:1817–1822CrossRefGoogle Scholar
  22. 22.
    Hayreh SS, Podhajsky PA, Raman R, Zimmerman B (1997) Giant cell arteritis: validity and reliability of various diagnostic criteria. Am J Ophthalmol 123:285–296CrossRefGoogle Scholar
  23. 23.
    Walvick MD, Walvick MP (2011) Giant cell arteritis: laboratory predictors of a positive temporal artery biopsy. Ophthalmology 118:1201–1204CrossRefGoogle Scholar
  24. 24.
    Kawasaki A, Purvin V (2009) Giant cell arteritis: an updated review. Acta Ophthalmol 87:13–32CrossRefGoogle Scholar
  25. 25.
    Gonzalez-Gay MA, Barros S, Lopez-Diaz MJ et al (2005) Giant cell arteritis: disease patterns of clinical presentation in a series of 240 patients. Medicine Baltimore 84:269–276CrossRefGoogle Scholar
  26. 26.
    Gabriel SE, O’Fallon WM, Achkar AA et al (1995) The use of clinical characteristics to predict the results of temporal artery biopsy among patients with suspected giant cell arteritis. J Rheumatol 22:93–96Google Scholar
  27. 27.
    González-López JJ, González-Moraleja J, Rebolleda G, Muñoz-Negrete FJ (2014) A calculator for temporal artery biopsy result prediction in giant cell arteritis suspects. Eur J Intern Med 25:e98–e100CrossRefGoogle Scholar
  28. 28.
    Daumann C, Putz R, Schmidt D (1989) The course of the superficial temporal artery. Anatomic studies as a prerequisite to arterial biopsy. Klin Monbl Augenheilkd 194:3741CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Ophthalmology, Carl Gustav Carus Faculty of MedicineTechnical UniversityDresdenGermany

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