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

• Published in: Seminars in arthritis and rheumatism Vol. 37; no. 1; pp. 13 - 19
• Main Authors: Narváez, Javier, MD, PhD, Bernad, Berta, MD, Roig-Vilaseca, Daniel, MD, García-Gómez, Carmen, MD, Gómez-Vaquero, Carmen, MD, PhD, Juanola, Xavier, MD, PhD, Rodriguez-Moreno, Jesús, MD, Nolla, Joan M., MD, PhD, Valverde, José, MD, PhD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.08.2007; Elsevier
• Subjects: Adrenal Cortex Hormones - administration & dosage; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Bones, joints and connective tissue. Antiinflammatory agents; Cohort Studies; corticosteroid treatment; Diseases of the osteoarticular system; Female; giant cell (temporal) arteritis; Giant Cell Arteritis - drug therapy; Giant Cell Arteritis - pathology; Humans; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Retrospective Studies; Rheumatology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Temporal Arteries - pathology; temporal artery biopsy yield; Time Factors; giant cell (temporal) arteritis; temporal artery biopsy yield; corticosteroid treatment; Human; Corticosteroid; Diseases of the osteoarticular system; Cardiovascular disease; Inflammatory joint disease; Vascular disease; Temporal artery; Chronic; Vasculitis; Treatment; Biopsy; Polymyalgia rheumatica; Systemic disease; Giant cell arteritis; Diagnosis
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2006.12.005

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.