Oral Presentation ARA-NSW 2017 - 39th Annual NSW Branch Meeting

Management of biopsy negative giant cell arteritis in a tertiary hospital (#15)

Gemma Winkler 1 , Jim Bertouch 1 , Amel Katrib 1 , Arvin Damodaran 1
  1. Rheumatology , Prince of Wales Hospital, Randwick, NSW, Australia

Background:    

Giant Cell Arteritis (GCA) also known as Temporal arteritis is a large to medium vessel vasculitis that typically affects the major branches of the aorta with a preference for the extra-cranial vessels off the carotid artery, including the temporal arteries(1, 2).

The ACR criteria 1990 for diagnosing GCA requires that three out of five criteria are met in order for a diagnosis to be made. Those criteria being age >50 years, ESR >50 mm/hr, new onset headache, an abnormal temporal artery on physical examination (tenderness or reduced/absent pulse) or positive temporal artery biopsy. Neither jaw claudication or visual disturbance are required to meet these ACR criteria(3).

As the criteria attest, a temporal artery biopsy is not required to make the diagnosis although it is still considered the gold standard investigation. However, the reported sensitivity of temporal artery biopsies varies widely from as low as 15% to as high as 87%(4, 5). Current management guidelines provide advice on steroid dosing for biopsy positive GCA, however, clinicians face uncertainty as to how to best manage biopsy negative GCA. 

Methods:

 All patients who underwent temporal artery biopsy between 2013-2016 at Prince of Wales hospital, Randwick had their files reviewed for details regarding characteristics, presentation, laboratory values, temporal artery biopsy results, diagnosis, management and relapses. 

Results:

 Preliminary results as to how management of biopsy negative GCA differs from biopsy positive GCA in one tertiary hospital will be presented at this meeting.

  1. 1. Weynand, CM et al. Medium and large vessel vasculitis. N Engl J Med 2003: 349:160-9
  2. 2. Weynand, Cm et al. The immunopathology of giant cell arteritis: diagnostic and therapeutic implications. J Neuroophthalmol 2012; Volume 32: 259-65.
  3. 3. Hunder, G et al. The American College of Rheumatology 1990 Criteria for the Classification of Giant Cell Arteritis. Arthritis and Rheumatism August 1990, Volume 33; No 8.
  4. 4. Christaudo, A et al The impact of Temporal artery biopsy on clinical practice. Annals of Medicine and Surgery. 2016 Volume 11:47-51.
  5. 5. Niederkohr, RD et al. A Bayesian analysis of the true sensitivity of a temporal artery biopsy. Invest Ophthalmol Vis Sci. 2007 Feb: 48 Volume 2:675-80.