Anatomoclinical results of temporal artery biopsies at a university hospital in Argentina
DOI:
https://doi.org/10.31053/1853.0605.v76.n4.21087Keywords:
review, giant cell arteritis, biopsyAbstract
Introduction: Giant cell arteritis (GCA) is the most frequent systemic vasculitis in patients older than 50 years. The diagnosis is based on the clinical history, laboratory findings and imaging studies associated with a temporal artery biopsy (TAB). However, the biopsy result could be inconclusive in up to 40% of the cases. The aim of this study was to review the current management of the patients with clinical suspect of GCA in the university hospital CEMIC in Buenos Aires, Argentina, and correlate the disease behavior with the TAB result. Methods: Retrospective study that reviewed consecutive patients to whom a TAB was made in an 11-year period (2005-2016). Clinical and pathology reports were reviewed. Descriptive statistics were performed. Quantitative variables were described as mean (S.D.) or median [range or inter- quartile range (IQR)] and qualitative variables as number (%). To compare the characteristics of the groups, bivariate analyzes were performed using contingency tables and logistic regression models if necessary. Results: Sixty three patients were included, 68% women. The mean age was 72 years old (SD 8.4). Seventeen biopsies (26.9%) were positive for GCA. The average post fixation length was 1.68 cm (SD 1.2). Patients were divided into 3 groups taking into account the result of the TAB, the ACR criteria and the imaging studies. We could not identify predictors of biopsy positivity. The group of patients with GCA and negative TAB showed a higher percentage of patients with abnormal temporal artery at physical examination. Conclusion: The TAB positive percentage (26.9%) was similar to the reported in other series as well as the post fixation length. We could not identify predictors of biopsy positivity.
Downloads
References
1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CGM, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DGI, Specks U, Stone JH, Takahashi K, Watts RA. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013 Jan;65(1):1–11.
2.Calamia KT, Hunder GG. Clinical manifestations of giant cell (temporal) arteritis. Clin Rheum Dis. 1980; 6:389-403.
3. Paulley JW, Hughes JP. Giant-cell arteritis, or arteritis of the aged. Br Med J. 1960 Nov 26;2(5212):1562–1567. doi: 10.1136/bmj.2.5212.1562.
4. Boesen P, Sørensen SF. Giant cell arteritis, temporal arteritis, and polymyalgia rheumatica in a Danish county. A prospective investigation, 1982-1985. Arthritis Rheum. 1987 Mar;30(3):294-9. doi: 10.1002/art.1780300308.
5. Levine SM, Hellmann DB. Giant cell arteritis. Curr Opin Rheumatol. 2002 Jan;14(1):3-10. doi: 10.1097/00002281-200201000-00002.
6 Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lie JT, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990 Aug;33(8):1122-8. doi: 10.1002/art.1780330810.
7. Weyand CM, Goronzy JJ. Clinical practice. Giant-cell arteritis and polymyalgia rheumatica. N Engl J Med. 2014 Jul 3;371(1):50-7. doi: 10.1056/NEJMcp1214825. PMID: 24988557; PMCID: PMC4277693.
8. Hauser WA, Ferguson RH, Holley KE, Kurland LT. Temporal arteritis in Rochester, Minnesota, 1951 to 1967. Mayo Clin Proc. 1971 Sep;46(9):597-602.
9. Egge K, Mitbo A, Westby R. Arteritis temporalis. Acta Ophthalmol. 1966; 44:49–56.
10. Roth AM, Milsow L, Keltner JL. The ultimate diagnoses of patients undergoing temporal artery biopsies. Arch Ophthalmol. 1984 Jun;102(6):901-3. doi: 10.1001/archopht.1984.01040030721028.
11. Gonzalez-Gay MA, Garcia-Porrua C, Llorca J, Gonzalez-Louzao C, Rodriguez-Ledo P. Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy. Semin Arthritis Rheum. 2001 Feb;30(4):249-56. doi: 10.1053/sarh.2001.16650.
12.Duhaut P, Pinède L, Bornet H, Demolombe-Ragué S, Dumontet C, Ninet J, Loire R, Pasquier J. Biopsy proven and biopsy negative temporal arteritis: differences in clinical spectrum at the onset of the disease. Groupe de Recherche sur l'Artérite à Cellules Géantes. Ann Rheum Dis. 1999 Jun;58(6):335-41. doi: 10.1136/ard.58.6.335.
13. Muratore F, Boiardi L, Cavazza A, et al. Correlations between histopathological findings and clinical manifestations in biopsy-proven giant cell arteritis. J Autoimmun. 2016;69:94–101. doi:10.1016/j.jaut.2016.03.005.
14. Mahr A, Saba M, Kambouchner M, Polivka M, Baudrimont M, Brochériou I, Coste J, Guillevin L. Temporal artery biopsy for diagnosing giant cell arteritis: the longer, the better? Ann Rheum Dis. 2006 Jun;65(6):826-8. doi: 10.1136/ard.2005.042770. PMID: 16699053; PMCID: PMC1798165.
15. Breuer GS, Nesher R, Nesher G. Effect of biopsy length on the rate of positive temporal artery biopsies. Clin Exp Rheumatol. 2009 Jan-Feb;27(1 Suppl 52):S10-3.
16. Marí B, Monteagudo M, Bustamante E, Pérez J, Casanovas A, Jordana R, Tolosa C, Oristrell J. Analysis of temporal artery biopsies in an 18-year period at a community hospital. Eur J Intern Med. 2009 Sep;20(5):533-6. doi: 10.1016/j.ejim.2009.05.002.
17. González-López JJ, González-Moraleja J, Burdaspal-Moratilla A, Rebolleda G, Núñez-Gómez-Álvarez MT, Muñoz-Negrete FJ. Factors associated to temporal artery biopsy result in suspects of giant cell arteritis: a retrospective, multicenter, case-control study. Acta Ophthalmol. 2013 Dec;91(8):763-8. doi: 10.1111/j.1755-3768.2012.02505.x.
18. Rodríguez-Pla A, Rosselló-Urgell J, Bosch-Gil JA, Huguet-Redecilla P, Vilardell-Tarres M. Proposal to decrease the number of negative temporal artery biopsies. Scand J Rheumatol. 2007 Mar-Apr;36(2):111-8. doi: 10.1080/03009740600991646.
19. Toren A, Weis E, Patel V, Monteith B, Gilberg S, Jordan D. Clinical predictors of positive temporal artery biopsy. Can J Ophthalmol. 2016 Dec;51(6):476-481. doi: 10.1016/j.jcjo.2016.05.021.
20. Walvick MD, Walvick MP. Giant cell arteritis: laboratory predictors of a positive temporal artery biopsy. Ophthalmology. 2011;118(6):1201–1204. doi:10.1016/j.ophtha.2010.10.002.
21. Smetana GW, Shmerling RH. Does this patient have temporal arteritis? JAMA. 2002 Jan 2;287(1):92-101. doi: 10.1001/jama.287.1.92.
22. Ball EL, Walsh SR, Tang TY, Gohil R, Clarke JM. Role of ultrasonography in the diagnosis of temporal arteritis. Br J Surg. 2010 Dec;97(12):1765-71. doi: 10.1002/bjs.7252.
23. Alba MA, Mena-Madrazo JA, Reyes E, Flores-Suárez LF. Giant cell arteritis in Mexican patients. J Clin Rheumatol. 2012 Jan;18(1):1-7. doi: 10.1097/RHU.0b013e31823e2e35.
24. Souza AW, Okamoto KY, Abrantes F, Schau B, Bacchiega AB, Shinjo SK. Giant cell arteritis: a multicenter observational study in Brazil. Clinics (Sao Paulo). 2013;68(3):317-22. doi: 10.6061/clinics/2013(03)oa06.
Downloads
Published
Issue
Section
License
Copyright (c) 2020 Universidad Nacional de Córdoba
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The generation of derivative works is allowed as long as it is not done for commercial purposes. The original work may not be used for commercial purposes.
How to Cite
