Temporal arteritis diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
The gold standard for diagnosing temporal arteritis is biopsy, which involves removing of a small part of the vessel and examining it microscopically for giant cells infiltrating the tissue. Since the blood vessels are involved in a patchy pattern, there may be unaffected areas on the vessel and the biopsy might have been taken from these parts. So, a negative result does not definitely rule out the diagnosis. Findings diagnostic of temporal arteritis include skip lesions and normal intervening segments, intimal thickening, with prominent cellular infiltration, lymphocytes in the internal or external elastic lamina or adventitia, areas of necrosis may be present in the arterial wall, granulomas containing multinucleated histiocytic and foreign body giant cells, helper T-cell lymphocytes, plasma cells, and fibroblasts. Risks of temporal artery biopsy are temporary or permanent damage to the temporal branch of the facial nerve, infection, bleeding, hematoma, and dehiscence.
Diagnostic Study of Choice
Study of choice
- Temporal artery biopsy is the gold standard test for the diagnosis of temporal arteritis.
- The following result of temporal artery biopsy is confirmatory of temporal arteritis:[1][2]
- Skip lesions and normal intervening segments
- Intimal thickening, with prominent cellular infiltration
- Lymphocytes in the internal or external elastic lamina or adventitia
- Areas of necrosis may be present in the arterial wall
- Granulomas containing multinucleated histiocytic and foreign body giant cells, helper T-cell lymphocytes, plasma cells, and fibroblasts[3]
- The temporal artery biopsy should be performed when:
- The patient presented with symptoms of temporal headache above age 50 years,and visual problems.
- Temporal arteritis is mainly diagnosed based on clinical presentation.
- Investigations:
- Among patients who present with clinical signs of temporal arteritis, the temporal artery biopsy is the most specific test for the diagnosis.[4]
- Clinical features of severity correlate with the histopathological changes on the temporal artery biopsy.[5]
- A positive biopsy after initiation of steroid treatment vary from 10% after 1 week to 86% after 4 or more weeks of treatment.[1][6]
- Most physicians with high clinical suspicion despite an initial negative biopsy would still recommend a second contralateral biopsy, given the consequences of a missed diagnosis of temporal arteritis.[7]
- Risks of temporal artery biopsy are temporary or permanent damage to the temporal branch of the facial nerve, infection, bleeding, hematoma, and dehiscence.
Video
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Diagnostic results
The following result of temporal artery biopsy is confirmatory of temporal arteritis:
- Skip lesions and normal intervening segments
- Intimal thickening, with prominent cellular infiltration
- Lymphocytes in the internal or external elastic lamina or adventitia
- Areas of necrosis may be present in the arterial wall
- Granulomas containing multinucleated histiocytic and foreign body giant cells, helper T-cell lymphocytes, plasma cells, and fibroblasts[3]
Diagnostic Criteria
- There are no established criteria for the diagnosis of temporal arteritis.
References
- ↑ 1.0 1.1 Pountain G, Hazleman B (1995). "ABC of rheumatology. Polymyalgia rheumatica and giant cell arteritis". BMJ. 310 (6986): 1057–9. PMC 2549437. PMID 7728064.
- ↑ Weyand CM, Fulbright JW, Hunder GG, Evans JM, Goronzy JJ (2000). "Treatment of giant cell arteritis: interleukin-6 as a biologic marker of disease activity". Arthritis Rheum. 43 (5): 1041–8. doi:10.1002/1529-0131(200005)43:5<1041::AID-ANR12>3.0.CO;2-7. PMID 10817557.
- ↑ 3.0 3.1 Liozon E, Ly KH, Robert PY (2013). "[Ocular complications of giant cell arteritis]". Rev Med Interne. 34 (7): 421–30. doi:10.1016/j.revmed.2013.02.030. PMID 23523078.
- ↑ Niederkohr RD, Levin LA (2007). "A Bayesian analysis of the true sensitivity of a temporal artery biopsy". Invest Ophthalmol Vis Sci. 48 (2): 675–80. doi:10.1167/iovs.06-1106. PMID 17251465.
- ↑ Moya Mir MS, Martín Jiménez T, Barbadillo R, Martín Martín F, Sánchez Ariño A, Magnani E (1981). "[Giant cell arteritis: diagnostic value of a second biopsy of the temporal artery (author's transl)]". Med Clin (Barc). 76 (10): 452–3. PMID 7242167.
- ↑ Ray-Chaudhuri N, Kiné DA, Tijani SO, Parums DV, Cartlidge N, Strong NP; et al. (2002). "Effect of prior steroid treatment on temporal artery biopsy findings in giant cell arteritis". Br J Ophthalmol. 86 (5): 530–2. PMC 1771122. PMID 11973248.
- ↑ Riordan-Eva P, Landau K, O'Day J (2001). "Temporal artery biopsy in the management of giant cell arteritis with neuro-ophthalmic complications". Br J Ophthalmol. 85 (10): 1248–51. PMC 1723724. PMID 11567973.