Diagnosis Of Arteritis Research Articles

3159 A Case of Takayasu's Arteritis in a Patient With Crohn's Disease

INTRODUCTION: Takayasu's Arteritis is a rare, chronic inflammation of the large vessels, particularly the aorta and its primary branches. Though etiology is largely unknown, the pathogenesis is thought to be due in part to inflammation in vascular tissue. The vast majority of cases worldwide have been in females from 10-40 years of age. Cases of Takayatsu's Arteritis have been reported in patients with Inflammatory Bowel Disease. CASE DESCRIPTION/METHODS: We present the case of a 41 y/o Caucasian female, with long standing Crohn's Disease (2006) who reports to our clinic for evaluation in 2010. At the time of presentation, Crohn's symptoms were mild. Over the next four years the patient had multiple flares and was treated with multiple agents. In 2017 she underwent a laparoscopic hemicolectomy after colonoscopy revealed a marked stricture proximal to her terminal ileum. DISCUSSION: Pathology from the surgery revealed a neuroendocrine tumor. Subsequent Osteoscan was negative but a CT revealed circumferential thickening of the proximal thoracic aorta at the origin of the left subclavian artery, indicative of aortitis. The findings were consistent with a diagnosis of Takayatsu's Arteritis.

31. Takayasu arteritis presenting as bilateral popliteal artery aneurysm: a rare presentation of a rare disease

IntroductionTakayasu arteritis (TA) is a rare, yet well recognised, chronic granulomatous arteritis that mostly affects large vessels in those below 50 years of age. According to the 2012 Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitides, Takayasu arteritis is classified as large vessel vasculitis as it mainly affects the aorta and its major branches. However, our patient is outside the norm as he has biopsy-proven Takayasu arteritis with no or little involvement of the aorta. Instead, he presented with bilateral popliteal artery aneurysm.Case descriptionThe patient is a healthy Yemeni gentleman. In 2011 (26-years-old), he started to complain of multiple joint pain and swelling associated with morning stiffness which was relieved after taking some medications. Incidentally, he was found to have high blood pressure which was not investigated as he was lost to follow-up.In 2016 (31-years-old), his symptoms recurred. He was diagnosed to have seronegative rheumatoid arthritis and started on csDMARDs, but he stopped them, and he was lost follow-up again.In July 2018 (33-years-old), he presented with complaints of painful swelling at the back of his right knee for around one month. The swelling was found to be a pulsatile mass and ultrasound was suggestive of popliteal artery aneurysm. CT angiography of lower limbs confirmed the presence of bilateral popliteal artery aneurysm. He underwent excision of the right aneurysm with vein interposition graft and rheumatology team was consulted.Apart from polyarthritis and hypertension, he denied any symptoms related to connective tissue diseases or vasculitides. He does not smoke. He was born to consanguineous parents but no family history of rheumatic or hereditary collagen disorders. He has normal body habitus, normal skin turgor, intact peripheral pulses and no evidence of synovitis.His laboratory workup revealed normal blood count, biochemistry panel and urinary studies but raised inflammatory markers. All serology and autoimmune workup came back negative. CT angiography of brain, chest and abdomen showed aortic ectasia with stenotic lesions in renal arteries. Biopsy of the resected aneurysm showed chronic inflammation with giant cells infiltrate compatible with TA.He was treated with steroids and intravenous cyclophosphamide pulse therapy for 6 months and then maintained on methotrexate. He is scheduled for angioplasty of the renal arteries.DiscussionDespite being considered a rare disease, Takayasu arteritis has been described in many parts of the Arab world. According to a 2014 systematic review by K Mustafa, the epidemiological and clinical features of TA in Arabs were similar to different parts of the world. However, this patient is unique in several ways. He presented mainly with episodes of inflammatory polyarthritis of large and small joints which was diagnosed as rheumatoid arthritis, because he did not have the usual constitutional symptoms (fever, weight loss, fatigue, and arthralgia) that are characteristic of the inflammatory phase of TA. The only clue that could have been used to point towards vasculitis as a cause of his symptoms was the overlooked high blood pressure which affects between 33–83% of patients with TA; reflecting the common involvement of the main renal arteries in TA. Hence, the delay in the diagnosis which is also a common finding in reported cases of TA worldwide. Most angiographic studies done to show the pattern of vascular involvement in TA showed that the thoracoabdominal aorta was the most common vessel involved, followed by the subclavian vessels with some differences between Japanese and Indian populations. However, many reported cases demonstrated the involvement of medium and small size vessels as well. CT angiogram of the patient did not convince us of any aortic involvement. However, there was stenotic lesions involving the renal arteries and aneurysmal dilatation of both popliteal arteries. This pattern of involvement that spared the aorta and its major branches raised the question of other types of vasculitides such as Behçet’s disease and polyarteritis nodosa, which made us treat him with intravenous cyclophosphamide initially. However, the clinical presentation and the biopsy supported the diagnosis of Takayasu arteritis rather than other vasculitides, so we have decided to maintain the patient on methotrexate.Key learning pointsPatients presenting with symmetric polyarthritis should be assessed thoroughly before labelling them as rheumatoid arthritis, especially if they are seronegative in order to not miss other important differential diagnoses such as in this case the diagnosis of vasculitis. Paying attention to other associated symptoms such as dermatologic or eyes manifestations or hypertension, can help in pointing towards other important differentials. Hypertension is an important and common manifestation of the vasculitides and can be the only presenting feature to unmask the presence of vasculitides. Therefore, vasculitides should be kept in the differential diagnosis of patients with secondary hypertension. TA is a disease of the aorta and its major branches. However, it can in rare situations affect other vessels and can present without involvement of the aorta. Conflicts of interestThe authors have declared no conflicts of interest.

Risk of ischaemic events at giant cell arteritis diagnosis according to PET/CT findings.

To analyse the risk of ischaemic events in patients with newly diagnosed giant cell arteritis (GCA) according to PET/CT findings. PET/CT was performed during the first 10days of steroid therapy. Clinical manifestations at diagnosis, and physical examination and PET/CT findings were recorded and compared according to the presence or absence of ischaemic symptoms at disease onset. Analysed territories included the ascending aorta, aortic arch, descending aorta, abdominal aorta, carotid arteries, brachiocephalic trunk, vertebral arteries, subclavian arteries and axillary arteries. The study group comprised 30 patients with a median age of 80.8years. Of these patients, 21 (70%) reported ischaemic symptoms at diagnosis, and 13 (43.3%) had permanent visual loss. Of the 30 patients, 77.8% showed large vessel vasculitis (including aortic and vertebral artery involvement) on PET/CT, and 60% had isolated involvement of the vertebral territory. Vertebral arteries were more frequently involved in patients with ischaemic symptoms (OR 5.0, 95% CI 0.99-24.86, p = 0.051). The presence of vertebral artery involvement in the absence of aortic involvement was associated with the presence of ischaemic manifestations (Fisher's exact test, p = 0.001). The presence of aortitis was found to protect against the development of permanent visual loss (OR 19.0, 95% CI 2.79-127.97, p = 0.001). Our findings suggest an association between the vascular pattern on PET/CT at the time of GCA diagnosis and the risk of ischaemic events.

The impact of temporal artery biopsy for the diagnosis of giant cell arteritis in clinical practice in a tertiary university hospital.

BackgroundTemporal artery biopsy (TAB) is useful in assisting with giant cell arteritis (GCA) diagnosis but lacks sensitivity. The aim of our study was to assess the diagnostic impact of TAB histology in patients with suspected GCA on hospital admission.MethodsA prospectively maintained database was queried for all TABs performed between 1-1-2000 until 31-12-2017 at the University Hospital of Ioannina. Thus, inclusion criteria were made on the grounds of every patient that underwent a TAB during the above-mentioned period, regardless of demographic, clinical and laboratory data.ResultsTwo hundred forty-five TABs were included (149 females and 96 males), with a mean age of 64.5 (±3.5) years. The mean symptoms duration until admission to the hospital was 8.6 (±1.3) weeks and all had elevated acute phase reactants on admission. The reasons of admission were fever of unknown origin (FUO) in 114 (46.5%) patients, symptoms of polymyalgia rheumatica (PMR) in 84 (34.3%), new headache in 33 (13.5%), anemia of chronic disease (ACD) in 8 (3.32%) and eye disturbances in 6 (2.5%) patients. Positive results were found in 49 (20%) TABs. More specifically, in 14% of patients with FUO, 21% in those with PMR, while in patients with a new headache the percentage was 27%. Finally, 5 out of 6 (83.3%) of patients with ocular symptoms and only one (12.5%) of those suffering from ACD. Visual manifestations and FUO are correlated with a positive TAB.ConclusionIt seems that TAB is useful in assisting with GCA diagnosis, but lacks sensitivity.

Increased incidence of spondyloarthropathies in patients with Takayasu arteritis: a systematic clinical survey.

Takayasu arteritis and Spondyloarthritis are two distinct inflammatory diseases that affect the same age periods. Increasing number of reports on co-incident Takayasu arteritis-spondyloarthritis cases in literature raised the hypotheses about their association. The purpose of this study is to evaluate the incidence of spondyloarthropathy spectrum diseases in Takayasu arteritis patients. Detailed clinical and demographic features of Takayasu arteritis patients were recorded and all were screened meticulously for the presence of spondyloarthropathy features following recommendations of Assessment of SpondyloArthritis international Society. Patients were questioned for inflammatory back pain, enthesitis, uveitis, inflammatory bowel disease, peripheral arthritis, and investigated accordingly with HLA-B27, plain X-rays and sacroiliac magnetic resonance imaging. A total of 69 Takayasu arteritis patients (65 female, 94.2%) were enrolled. After detailed investigation, 14 (20.3%) Takayasu arteritis patients fulfilled the Assessment of SpondyloArthritis international Society criteria for Spondyloarthropathy. Two of 14 (14.2%) spondyloarthropathy patients were positive for HLA-B27. Type 1 and type 2 Takayasu arteritis were more common in patients with diagnosis of both Takayasu arteritis and spondyloarthropathy than those without spondyloarthropathy. Most of patients with diagnosis of both these diseases required biologic therapies than patients with diagnosis of Takayasu arteritis alone (64.3% vs 29.1%, P = 0.014) due to refractory Takayasu arteritis. Our results suggest a significant association between Takayasu arteritis and spondyloarthropathy. Possible shared genetic or immunopathogenic processes may explain this association, which merits further investigations.

Role of Contrast-Enhanced Ultrasound Sonography in the Medical Diagnostics of the Disease Activity in Patients With Takayasu Arteritis

The accurate diagnosis of Takayasu arteritis (TA) and the evaluation of its activity can bring significant challenges. In this paper, we sought to investigate a correlation between clinical activity and the enhancement of vessel wall acquired by contrast-enhanced ultrasound sonography (CEUS) in patients with TA, and to evaluate whether CEUS can be used to assess the disease activity of TA. Twenty TA patients with their carotid arteries affected were enrolled and divided into the active group and the inactive group according to the NIH scoring method. The white blood cell counts, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were obtained. Conventional ultrasound was performed to acquire the external diameter of the artery (D), intima-media thickness of the arterial wall (IMT), percent area stenosis, peak systolic velocity, end diastolic velocity, and resistance index. CEUS was performed to acquire the enhanced intensity (EI), derived peak intensity (DPI), and time to peak. The analysis showed that compared with the inactive group, D and IMT were significantly higher in the active group ( $6.50~\pm ~1.80$ versus $9.20~\pm ~4.00$ mm, $1.80~\pm ~0.40$ versus $2.40~\pm ~0.70$ mm, $p ). EI and DPI were also significantly higher in the active group ( $38.20~\pm ~10.62$ versus $80.80~\pm ~23.60$ IU, $46.20~\pm ~10.20$ versus $90.30~\pm ~24.60$ IU, $p ). Meanwhile, EI and DPI showed good correlation with CRP and ESR. Therefore, our study demonstrated that CEUS can increase the effectiveness of conventional ultrasound in differentiating active and inactive TA.

Giant Cell Arteritis Diagnosis by Biopsy or Ultrasound: Are we Classifying a Homogeneous Population?

Giant cell arteritis (GCA) is a granulomatous vasculitis with autoimmune origin that is defined by the presence of mononuclear cell infiltrates and the formation of giant cells. It appears in elderly patients and involves the aorta and its branches, particularly the superficial temporal artery. In these patients, rapid diagnosis and immediate initiation of treatment are essential to prevent vascular complications, particularly visual loss and ischemic stroke.

Diagnostic Utility of Computed Tomographic Angiography in Giant-Cell Arteritis.

Background and Purpose- The diagnosis of giant-cell arteritis (GCA) is challenging. Superficial temporal artery biopsy and ultrasound are positive in only 50%. We evaluated computed tomographic angiography (CTA) of the head in GCA. Methods- This case-control study was performed using a prospective GCA registry. Cases presented with stroke symptoms, had a CTA, and were subsequently diagnosed with GCA. Age- and sex-matched controls presented with stroke symptoms, had a CTA, and were not diagnosed with GCA. CTAs were evaluated for the presence of superficial temporal artery abnormalities. Results- Fourteen cases met the inclusion criteria and were matched with 14 controls. Blurred vessel wall margins and perivascular enhancement was found in 10 cases (71.4%) and 2 controls (14.3%). CTA has an accuracy of 78.6%, sensitivity of 71.4%, and a specificity of 85.7% for GCA. Conclusions- CTA detects superficial temporal artery abnormalities in GCA. This may facilitate early diagnosis and prompt implementation of potentially sight-saving and stroke-preventing treatment.

Evolution into Takayasu arteritis in a patient presenting with acute pulmonary oedema due to severe aortic regurgitation; a case report

BackgroundTakayasu arteritis is a rare large vessel vasculitis which predominantly affects young Asian females. Aortic regurgitation and heart failure are well described manifestations which are usually preceded by constitutional symptoms, limb claudication, pulse and blood pressure discrepancies, vascular bruits and features of organ ischaemia.Case presentationA 25-year- old Sri Lankan female presented with a three days history of acute shortness of breath, cough and orthopnoea. On examination she had severe aortic regurgitation resulting in high output cardiac failure. There was no evidence of acute coronary ischaemia or infective endocarditis. The only significant investigation finding was an elevated erythrocyte sedimentation rate (ESR) of 114 mm/first hour. The patient was treated for pulmonary oedema and empirically for infective endocarditis. Extensive evaluation for an underlying infection, large vessel vasculitis or malignancy did not reveal any abnormalities. Detailed periodic assessment identified reduced blood pressure in left arm (70/40 mmHg) compared to right (100/70 mmHg) and reduced pulse volume of left arm with left subclavian bruit more than one year after the initial presentation. Digital subtraction angiography revealed significant stenosis at first part of left subclavian and origin of left vertebral arteries. A diagnosis of Takayasu arteritis was made and patient was started on high dose glucocorticoids.ConclusionsTakayasu arteritis can present initially with isolated cardiac involvement even as acute cardiac manifestations and high degree of suspicion with close follow up would allow early detection of development of other classic features and timely diagnosis.

Negative temporal artery biopsy: predictive factors for giant cell arteritis diagnosis and alternate diagnoses of patients without arteritis.

To investigate whether among patients with a negative temporal artery biopsy (TAB) there are clinical features that may differentiate between patients with an eventual diagnosis of giant cell arteritis (GCA) and those without arteritis, and to assess the eventual diagnoses of patients without arteritis. Retrospective analysis of patients with a negative TAB performed between 1/1/2000 and 31/12/2015. Information collected included baseline clinical and laboratory data. Patients' final diagnoses were obtained from medical records. Patients eventually diagnosed with GCA were compared with those without arteritis, and predictive features for GCA diagnosis were assessed. A total of 154 patients with a negative TAB were included in the study. Among them, 31 (20%) were eventually diagnosed with GCA. The leading alternative diagnoses of patients without arteritis were self-limited disease (23%), isolated polymyalgia rheumatica (PMR) (18%), and neurological conditions (17%). In the multivariate analysis, predictors for diagnosis of GCA among patients with a negative TAB included PMR (OR = 2.86, 95% CI 1.06-7.69), platelet count (OR = 1.28, 95% CI 1.07-1.53), and ACR score > 2 (OR = 13.4, 95% CI 4.27-42.03). Among patients with a negative TAB, the best predictors for diagnosis of GCA are fulfillment of the ACR criteria, a clinical diagnosis of PMR, and high platelet levels. These features may aid in the diagnostic work-up of patients with a negative TAB.

The role of ultrasound biomicroscopy in predicting the result of temporal artery biopsy in temporal arteritis patients: A preliminary study.

Temporal artery biopsy is considered the gold standard for the diagnosis of temporal arteritis (TA). However, complications following this procedure may occur. The goal of this study is to evaluate if ultrasound biomicroscope (UBM) findings are useful in predicting the result (positive or negative) of temporal artery biopsy in patients with TA. Twenty-six consecutive patients with clinical diagnosis of TA seen at the Department of Ophthalmology, Royal Victoria Hospital, Montreal, Canada, were involved in this study. All patients were submitted to UBM before temporal artery biopsy. Eight patients presented histopathologic findings consistent with the diagnosis of TA. Thus, UBM findings of these patients were compared with those from 18 patients with negative biopsy. On UBM we searched for the presence of a hypoechoic effect surrounding the walls of the temporal arteries, the so-called halo sign, as well as an intra-arterial middle reflexive filling, the so-called intra-arterial filling. The halo sign and/or the intra-arterial filling were found in 8 (100%) of 8 patients with biopsy-proven TA. However, 10 (55.5%) of 18 patients with a negative biopsy presented one or both of these two UBM findings. On the other hand, the absence of these two parameters on the UBM of a patient with TA strongly suggests that the temporal artery biopsy will be negative (negative predictive value=100%). This preliminary work suggests that UBM may play a role in predicting a negative result of the temporal artery biopsy in patients with TA. In the present series approximately 30% of the patients could be spared this surgical procedure and its possible complications.

Takayasu arteritis a cause of hypertensive disorder of pregnancy: a case report

BackgroundTakayasu arteritis is a rare, chronic, granulomatous systemic vasculitis of unknown etiology and a few cases have been reported in pregnancy. In pregnancies concomitant with Takayasu arteritis or after diagnosis, Takayasu arteritis negatively affects pregnancy by increasing 13-fold the odds of complications such as hypertensive disorders. The best recommendations in this scenario are still to be made.Case presentationWe present a case of 21-year-old, gravid 1, Mexican woman of Mestizo descent with chronic hypertension diagnosed since she was 15-years old who presented severe hypertension during pregnancy (early second trimester); the diagnosis of hypertensive disorder of pregnancy was ruled out requiring first-line and second-line antihypertensive therapy without serious associated maternal or fetal morbidity.ConclusionsTakayasu arteritis and pregnancy play an important role in maternal and fetal outcomes. Efforts should be made to further investigate the Takayasu arteritis diagnosis in pregnant women with refractory hypertension.

Tongue paralysis progressing to tongue necrosis with subsequent diagnosis of temporal arteritis in a patient without precipitating exposure to ergotamine

Tongue paralysis progressing to tongue necrosis with subsequent diagnosis of temporal arteritis in a patient without precipitating exposure to ergotamine

Pyoderma gangrenosum with Takayasu's arteritis: A rare association

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by destructive, necrotizing, and noninfective ulceration of skin which most commonly involve lower extremities. We are reporting a case of 20-year-old male who presented with multiple nodulo-ulcerative plaques on both thighs which showed histopathological findings of granulomatous reaction. He was initially treated ineffectively with anti-tubercular agents. Following a revised diagnosis of PG, dexamethasone pulse therapy (100 mg daily for 3 consecutive days in a month) was initiated and the lesions improved with three such pulses. However, the patient was lost to follow-up. The patient presented a year later with relapse and pulse therapy was restarted. Incidental finding of absence of peripheral pulse and nonrecordable blood pressure on left upper limb led to the diagnosis of Takayasu's arteritis (TA). Skin lesions improved and the patient was referred for the management of TA. Association of PG with TA is rare and very few cases have been reported from India till date.

Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis.

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.

Takayasu arteritis in paediatrics.

Takayasu arteritis is an idiopathic chronic granulomatous panarteritis predominantly affecting the aorta and its main branches. Although idiopathic, genetic contribution to disease susceptibility is being increasingly recognised. Rare in children, Takayasu arteritis is a worldwide disease with significant morbidity and mortality. Its diagnosis is a challenge and requires awareness of the condition as clinical features at presentation are non-specific and assessing disease activity is difficult. In the inflammatory stage, treatment is essential to prevent the insidious course and vascular damage: stenotic, occlusive lesions, aneurysms, and aortic regurgitation. New imaging modalities, such as CT scan, MRI, and 18F-fluorodeoxyglucose positron emission tomography, have expanded the possibilities for non-invasive diagnosis and monitoring; however, digital subtraction arteriography remains the gold standard for the diagnosis of Takayasu arteritis. Steroids are the first-line medical treatment. The combined use of methotrexate, cyclophosphamide, azathioprine, mycophenolate mofetil, and biological agents is common. Revascularisation therapy should be considered in uncontrolled hypertension secondary to renal artery stenosis, symptomatic coronary ischaemia, cerebrovascular disease, severe aortic regurgitation, limb ischaemia, and aneurysms at risk of rupture, using surgical or endovascular procedures and taking into consideration that complications, especially restenosis, are frequent. Disease activity increases the likelihood of complications after revascularisation. Surgical intervention has shown better long-term outcomes, although the endovascular approach is evolving. The aim of this review was to describe key points of the diagnosis, treatment, and follow-up of Takayasu arteritis in childhood.

Imaging modalities for the diagnosis and disease activity assessment of Takayasu's arteritis: A systematic review and meta-analysis.

Early diagnosis of Takayasu's Arteritis (TAK) and detection of disease activity may reduce the risk of vascular complications. The objective of this study was to determine the effectiveness of imaging modalities for the management of TAK. MEDLINE and EMBASE were searched for studies of patients undergoing various imaging modalities for TAK diagnosis or to assess disease activity. We excluded case reports, reviews and case series with <10 patients. The methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Random effects meta-analyses with inverse-variance weighting were performed. From the 1126 citations screened, 57 studies met our inclusion criteria. Many of the studies were of small sample size (average N=27), cross-sectional design and low methodological quality. Ultrasound (US) had a lower pooled sensitivity (SN) of 81% (95% CI: 69-89%) than Magnetic Resonance Angiography (MRA) with SN=92% (95% CI: 88-95%) for TAK diagnosis (by clinical criteria and/or X-Ray angiography). Both had high specificities (SP) of >90% for TAK diagnosis. Fewer studies investigated computed tomography angiography (CTA), but SN and SP for TAK diagnosis was high (>90%). The utility of vessel wall thickening and enhancement by MRA and CTA to predict disease activity varied across studies. The pooled SN and SP of 18F-fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) for disease activity was 81% (95% CI: 69-89%) and 74% (95% CI: 55-86%), respectively. US, CTA and/or MRA are effective for the diagnosis of TAK. The utility of these imaging modalities for assessing disease activity remains unclear.

Clinical correlation of biopsy results in patients with temporal arteritis.

Temporal arteritis is systemic vasculitis of medium and large sized vessels. The lowest incidence rates were reported in Turkey, Japan and Israel. We aimed to investigate the results of patients with biopsy-proven temporal arteritis and those classified according to the American College of Rheumatology criteria from a low-incidence region for temporal arteritis. The results of our study are noteworthy, since there is limited data on pathologic diagnosis of temporal arteritis in Turkey. We studied the medical records, laboratory findings such as erythrocyte sedimentation rate and C-reactive protein levels, biopsy results, and postoperative complications of all the patients operated for temporal artery biopsy at our clinic. We used the computerized laboratory registry that keeps all records of 42 consecutive temporal artery biopsy results from January 2011 to December 2016. The mean age was 66±12.5 years. The most common manifestations on admission were temporal headache, optic neuritis and jaw claudication, respectively. Temporal artery biopsy results confirmed tempoal arteritis in eight out of 42 (19%) patients. There was no statistically significant difference between biopsy-positive and biopsy-negative groups in terms of sex, age, erythrocyte sedimentation rate, C-reactive protein and biopsy length. We were not able to find a correlation between the analysis of biopsy results and clinical evaluation of patients with temporal arteritis. We suggest that diagnosis of temporal arteritis depends on clinical suspicion. Laboratory examination results may not be helpful in accurate diagnosis of tempoal arteritis.

Is PET/CT essential in the diagnosis and follow-up of temporal arteritis?

The increasing availability and improvement of imaging techniques are deeply influencing diagnosis and work-up of patients affected with vasculitis, particularly those with large vessel vasculitis (LVV). Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET), especially when integrated with computed tomography (CT), is taking hold as a useful diagnostic technique to examine the aorta and the other large vessels in giant cell arteritis (GCA) with concomitant large vessel involvement (LV-GCA). In this paper we examined the progresses performed in this field in the last twenty years and the evidence available so far according to two different points of view ('pros' and 'cons'), in order to give a comprehensive answer to a still open question about the role of PET/CT in the diagnosis and follow-up of GCA.

Temporal artery biopsy in the diagnosis of giant cell arteritis: Bigger is not always better

ObjectiveAccurate early giant cell arteritis (GCA) diagnosis can be established through temporal artery biopsy (TAB). We herein investigate the relationship between specimen length and positive TAB result in a tertiary-care hospital in Germany during a 8-year period. Secondarily, we studied the relationships of specific epidemiological and laboratory parameters with positive TABs. MethodWe retrospectively reviewed the medical records of all patients with suspected GCA, who underwent TAB in our institution. ResultsThe total sample consisted of 116 patients with a mean age of 76.1 (SD 7.7) years. Mean specimen length post-fixation was 0.94 cm (SD 0.49). The TAB(+) group consisted of 64 patients (55.2%). The specimen length was comparable in the two groups (0.96 cm vs 0.91 cm, p = 0.581). Twenty six TAB(+) patients (41%) had a post-fixation specimen longer than 1 cm, comparable with the respective percentage in the TAB(−) group (42%, p = 1). All laboratory tests performed were statistically significantly different in the two groups. ConclusionWe conclude that TAB length is not associated with the TAB diagnostic yield in patients with clinical suspicion of GCA.