Significance of inflammation restricted to adventitial/periadventitial tissue on temporal artery biopsy
Elena Galli1, Francesco Muratore2, Luigi Boiardi2
1University of Modena and Reggio Emilia, Modena, Italy.
Objective:
To evaluate the characteristics and significance of inflammation restricted (RI) to the adventitial and/or periadventitial tissue on temporal artery biopsy (TAB).
Methods:
We studied a retrospective cohort of 80 patients with RI, extending our earlier series of 39 patients. For comparison purposes, we collected the same data from 254 patients with transmural inflammation (TMI) and 81 TAB-negative patients. A review of the literature was also performed.
Results:
A final diagnosis of giant cells arteritis (GCA) and/or polymyalgia rheumatica (PMR) was observed in 86% of patients with RI. Compared to TMI, GCA diagnosis was significantly less frequently observed in patients with RI and in those TAB-negative (p < 0.0001), while cranial manifestations were significantly less frequent (p = 0.001) and ESR and CRP values at diagnosis significantly reduced (p < 0.0001). PMR, permanent visual loss, and large vessel involvement at diagnosis were equally present in the 3 subgroups. The median duration of prednisone therapy, the cumulative prednisone dosages, and the relapse and long-term remission rates were similar between patients with GCA-RI and those with TMI. The positive likelihood ratios (LRs) of pathological evidence of RI at TAB for GCA or GCA/PMR diagnoses were 0.88 (CI, 0.61-1.27) and 1.15 (CI, 0.67-1.99), while that of inflammation limited to adventitia was 1.37 (CI, 0.59-3.19) and 3.77 (CI, 0.53-26.72). In the literature review, the positive LR of RI for GCA diagnosis was 0.92 (CI, 0.68-1.25).
Conclusion:
A large part of the patients with RI have GCA/PMR, however, the diagnostic value of RI for GCA diagnosis is not relevant.
Insights
Inflammation restricted to the adventitia on temporal artery biopsy is often seen in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR). However, its diagnostic value for GCA is not significant.
Area of Science:
- Rheumatology
- Pathology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are common vasculitides.
- Temporal artery biopsy (TAB) is a key diagnostic tool.
- Inflammation patterns in TAB can vary, impacting diagnosis.
Purpose of the Study:
- To evaluate the characteristics and diagnostic significance of inflammation restricted (RI) to the adventitia and/or periadventitia on TAB.
- To compare RI findings with transmural inflammation (TMI) and TAB-negative cases.
Main Methods:
- Retrospective cohort study of 80 patients with RI, compared to 254 with TMI and 81 TAB-negative patients.
- Literature review performed to assess diagnostic value.
- Analysis of clinical data, inflammatory markers (ESR, CRP), and treatment outcomes.
Main Results:
- 86% of RI patients had a final diagnosis of GCA and/or PMR.
- GCA diagnosis and cranial manifestations were less frequent in RI and TAB-negative groups compared to TMI.
- ESR and CRP levels were significantly lower in the RI group.
- Treatment duration, dosages, relapse, and remission rates were similar between GCA-RI and TMI groups.
Conclusions:
- A significant proportion of patients with RI on TAB have GCA/PMR.
- The diagnostic value of RI for GCA is not considered relevant.
- RI findings alone do not strongly support a GCA diagnosis.
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