Abstract
BackgroundTemporal artery biopsy (TAB) is a surgical procedure with a low positive yield. The purpose of this study is to determine which variables are the most important in the giant cell arteritis (GCA) diagnosis. The objective of this evaluation is to improve the percentage of positive temporal artery biopsy and if possible, avoid the biopsy in some cases.Material and MethodsA retrospective clinical study consisted of 90 patients who had undergone TAB at the Río Hortega Hospital (Spain) from January 2009 to December 2016. Clinical findings, erythrocyte sedimentation rates (ESR) and other laboratory parameters, American College of Rheumatology (ACR) criteria for GCA score and biopsy results were recorded.ResultsNineteen (21.1%) biopsies were positive for GCA. The mean age in positive TAB was 78.6 years old (SD 7.93), and 73.7% were female. Presence of temporal headache (p = 0.003), jaw claudication (p = 0.001), abnormal artery exploration (p = 0.023), elevated erythrocyte sedimentation rate (p = 0.035), CRP (p = 0.018) and platelets (p = 0.042), were significantly associated with GCA. Multivariate logistic regression revealed that the best predictors for the diagnosis of GCA are headache and jaw claudication, adjusted by sex, age, and temporal exploration.ConclusionsTAB has benefit only for patients who score a 2 or 3 on the ACR criteria for GCA without biopsy. These findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis. Key words:Giant cell arteritis, horton arteritis, vasculitis, temporal artery biopsy, jaw claudication, temporal headache.
Highlights
Giant cell arteritis (GCA), known as temporal or granulomatous arteritis, described by Horton in 1932, is a relatively common form of blood vessel inflammation, which usually affects people over the age of 50, with peak incidences occurring between the ages of 70 and 80 [1]
The mean erythrocyte sedimentation rates (ESR) value in positive Temporal artery biopsy (TAB) cases was 69.16 mm/h (SD 28.9), elevated value was significantly associated with giant cell arteritis (GCA) (p = 0.035) and mean C-reactive protein (CRP) value was 108.79 mg/l (SD 64.4, p =0.018)
Positive TAB is correlated with a lower hemoglobin level (73.7% of patients had anemia) but is not significantly associated with a positive TAB
Summary
Giant cell arteritis (GCA), known as temporal or granulomatous arteritis, described by Horton in 1932, is a relatively common form of blood vessel inflammation, which usually affects people over the age of 50, with peak incidences occurring between the ages of 70 and 80 [1]. This affectation is the most common characteristic of GCA, it is only present in less than half of the cases based on different studies [4] The importance of this symptom and temporal headache, is that it can be the reason to consult an oral and maxillofacial surgeon. Temporal artery biopsy (TAB) is the current gold standard test for establishing the diagnosis, with a high specificity but low sensitivity It can be misleading in a significant number of cases. The purpose of this study is to determine which variables are the most important in the giant cell arteritis (GCA) diagnosis The objective of this evaluation is to improve the percentage of positive temporal artery biopsy and if possible, avoid the biopsy in some cases. These findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis
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