[Temporal arteritis: do not rely on the erythrocyte sedimentation rate]
1Ziekenhuisgroep Twente, afd. Reumatologie, Almelo/Hengelo.
Insights
Normal erythrocyte sedimentation rate (ESR) tests can mislead diagnoses of temporal arteritis. Elevated C-reactive protein (CRP) levels are more consistently found in patients with this condition.
Area of Science:
- Rheumatology
- Clinical Pathology
Background:
- Temporal arteritis, also known as giant cell arteritis, is an inflammation of arteries, typically in the head.
- Accurate diagnosis is crucial to prevent complications like vision loss.
Observation:
- Two patients with suspected temporal arteritis were misdiagnosed due to normal erythrocyte sedimentation rate (ESR) results.
- A third patient showed significant discrepancies between ESR measurements from two different methods (Alifax Test-1TH and Westergren).
- C-reactive protein (CRP) levels were elevated in all three presented cases.
Findings:
- ESR may not be a reliable sole indicator for diagnosing temporal arteritis.
- The Alifax Test-1TH apparatus demonstrated lower sensitivity for ESR compared to the Westergren method in one case.
- Elevated CRP levels were observed in a high percentage (96%) of biopsy-proven temporal arteritis cases, even when ESR was not significantly elevated.
Implications:
- Clinicians should consider using both ESR and CRP tests when evaluating patients for temporal arteritis.
- Further evaluation of the Alifax Test-1TH's performance in detecting temporal arteritis is warranted.
- Integrating clinical signs, symptoms, and advanced imaging may improve the recognition of cranial giant cell arteritis.
Abstract:
Three patients with signs of temporal arteritis are presented. In two patients a normal ESR resulted in the diagnosis 'temporal arteritis' being discarded, prompting clinicians to consider meningitis, sinusitis, and blindness due to atherosclerosis. In the third case, the ESR measured with the Alifax Test-1TH apparatus was 17 mm/h, whereas the Westergren method used on the same sample resulted in an ESR of 83 mm/h. In all three cases CRP was elevated. On the basis of literature on the sensitivity of ESR and CRP it is advisable to use both measures when temporal arteritis is being considered. It is noted that in one hospital using the Alifax Test-1TH, only 52% of 25 patients with biopsy-proven temporal arteritis had an ESR over 40 mm/h, while 96% had elevated CRP. This observation requires further evaluation. The significance of signs, symptoms and new imaging techniques for recognising cranial giant cell arteritis is summarised.
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