Influence of Previous Corticosteroid Therapy on Temporal Artery Biopsy Yield in Giant Cell Arteritis

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Objective

To determine the impact of prior corticosteroid treatment on temporal artery biopsy (TAB) yield to establish the diagnosis of giant cell arteritis (GCA).

Methods

Retrospective study of a consecutive cohort of 78 patients clinically diagnosed and managed as GCA, who received corticosteroids before TAB.

Results

Among the 78 patients, TAB was positive in 57 (73%) and negative in 21 (27%). No significant differences in the length of the specimen were found between the positive and negative biopsies.

We grouped patients according to treatment duration before TAB. In those with newly diagnosed GCA treated with high-dose steroid therapy, the biopsy results were positive in 78% (35/45) of patients treated for less than 2 weeks, in 65% of those treated for 2 to 4 weeks (13/20), and in 40% of those treated for more than 4 weeks (2/5). We also observed 8 patients that developed GCA on a background of a prior history of polymyalgia rheumatica (PMR); in this group biopsy was positive in 88% of the cases, after a median duration of treatment of 180 ± 172 days and an average daily dose of 7.1 ± 1.4 mg/d.

Conclusion

The performance of TAB should not delay the prompt institution of steroid therapy on diagnosis of GCA, since the diagnostic yield of TAB seems valuable within 4 weeks of starting high-dose steroid treatment. In patients that developed GCA on a background of a prior history of PMR, a late TAB is also generally informative despite long-term treatment with low doses of corticosteroids.

Section snippets

Patients and Methods

We conducted a retrospective study of all patients diagnosed with GCA by the Department of Rheumatology within the Hospital Universitario de Bellvitge (Barcelona, Spain) from January 1986 until December 2004. We primarily determined, from medical records, whether each patient had received steroid treatment before TAB.

During this time, a total of 121 patients were diagnosed with GCA; 78 patients (64%) who received corticosteroids before biopsy were eligible to be included in our study. The

Study Sample and Overall Biopsy Results

The main clinical features and laboratory data of the 78 patients included in the study are summarized in Table 1. All patients were referred to the hospital from the primary care unit or they self-referred to the emergency room. The principle motives for the initiation of corticosteroid treatment before TAB were the presence of visual manifestations at diagnosis (18 cases), delay in performance of the biopsy due to surgical waiting lists (27 cases), and institution of steroid treatment by

Discussion

Patients with untreated GCA are more susceptible to blindness (which is generally irreversible unless aggressively treated within 24 to 48 hours of onset), strokes, and other manifestations of cranial ischemic complications. This has led to a general consensus among clinicians that corticosteroid treatment is necessary in subjects with suspected GCA. Most authorities recommend starting the therapy as soon as the diagnosis is suspected; as a result, initiation of corticosteroids on clinical

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