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Updated: Sep 14, 2025

An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis

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Normal inflammatory markers in giant cell arteritis: a diagnostic blind spot

Cara E Currier1, A M Bays2, J L Thomason3

  • 1Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA.

Rheumatology International
|July 19, 2025
PubMed

Insights

Giant cell arteritis (GCA) diagnosis can be challenging with normal inflammatory markers like ESR and CRP. A longer delay in testing increases the likelihood of normal results, but GCA presentation remains similar.

Area of Science:

  • Rheumatology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Giant cell arteritis (GCA) is a critical vasculitis requiring prompt diagnosis.
  • Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) are key diagnostic markers, but some GCA patients exhibit normal levels.
  • This variability necessitates exploring alternative diagnostic approaches when inflammatory markers are inconclusive.

Purpose of the Study:

  • To compare the clinical presentation and vascular ultrasound findings in GCA patients with normal versus elevated inflammatory markers.
  • To evaluate the diagnostic accuracy of ESR and CRP in detecting GCA.
  • To identify factors associated with normal inflammatory markers in GCA patients.

Main Methods:

  • Retrospective analysis of GCA patients diagnosed via a Fast Track Clinic (FTC).
  • Comparison of clinical presentation and ultrasound results between GCA patients with normal (n=23) and elevated (n=107) inflammatory markers.
  • Calculation of ESR and CRP sensitivity and specificity using an additional 159 non-GCA patients.

Main Results:

  • C-Reactive Protein (CRP) showed 74% sensitivity and 49% specificity; Erythrocyte Sedimentation Rate (ESR) demonstrated 48% sensitivity and 72% specificity for GCA detection.
  • Patients with normal inflammatory markers had a significantly longer duration between symptom onset and marker measurement (35 vs. 20 days).
  • No significant differences in clinical presentation were observed between GCA patients with normal or elevated inflammatory markers.

Conclusions:

  • GCA patients exhibit similar clinical presentations irrespective of their inflammatory marker status.
  • A prolonged interval from symptom onset to inflammatory marker testing is associated with normal ESR and CRP levels in GCA.
  • Low inflammatory marker levels should not deter a comprehensive diagnostic work-up for GCA.
Abstract

Keywords:
Blood sedimentationC-Reactive proteinGiant cell arteritisVasculitis

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