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Diagnosis of giant cell arteritis: when should we biopsy the temporal artery?

Omar Hussain1, Andrew McKay2, Kevin Fairburn3

  • 1Oral and Maxillofacial Department, Doncaster and Bassetlaw Foundation Trust.

The British Journal of Oral & Maxillofacial Surgery
|January 21, 2016
PubMed

Insights

Giant cell arteritis (GCA) diagnosis can be improved by using the American College of Rheumatology (ACR) classification. This study found that clinical diagnosis via ACR criteria often precedes temporal artery biopsy confirmation, suggesting optimized referral criteria.

Area of Science:

  • Rheumatology
  • Pathology
  • Surgical Oncology

Background:

  • Giant cell arteritis (GCA) is a vasculitis diagnosed via temporal artery biopsy and clinical assessment using the American College of Rheumatology (ACR) 5-point score.
  • The current diagnostic pathway may lead to unnecessary biopsies, impacting patient care and resource allocation.

Purpose of the Study:

  • To evaluate the diagnostic utility of the ACR classification in identifying GCA in patients referred for temporal artery biopsy.
  • To determine if clinical diagnosis based on ACR criteria can reliably predict histopathological findings, thereby reducing unnecessary referrals.

Main Methods:

  • A retrospective audit of 100 patient referrals for temporal artery biopsy was conducted over 34 months.
  • Patients were assessed using the 1990 ACR classification criteria to determine clinical GCA diagnosis at referral.
  • Referral data and biopsy results were compared to calculate diagnostic accuracy metrics.

Main Results:

  • Of 98 patients who underwent biopsy, 15 were diagnosed with GCA. Thirteen of these had a prior clinical diagnosis based on ACR criteria.
  • The ACR classification demonstrated high specificity (96%) but low sensitivity (20%) for diagnosing GCA.
  • A linear correlation was observed between higher ACR scores and histopathological confirmation of GCA.

Conclusions:

  • Temporal artery biopsy for GCA is most beneficial in cases of diagnostic uncertainty (ACR score 1 or 2), atypical presentations, or when steroid contraindications exist.
  • The ACR classification is a valuable tool for refining GCA diagnosis and optimizing referral for temporal artery biopsy.
  • A new referral form based on ACR criteria was designed to improve patient selection for biopsy.

Keywords:
Giant Cell ArteritisTemporal Cell ArteritisTemporal artery biopsy

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