Biopsy-negative giant cell arteritis: Clinical spectrum and predictive factors for positive temporal artery biopsy*,**

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Abstract

Objectives: To examine the frequency and features of patients with biopsy-negative giant cell arteritis (GCA), establish differences with biopsy-proven GCA, and identify the optimal set of predictors for a positive temporal artery biopsy (TAB) in patients with GCA. Methods: Retrospective study of an unselected population of patients with GCA diagnosed at the reference hospital for a defined population between 1981 and 1998. Patients were classified into biopsy-proven GCA if a TAB was positive for GCA, or biopsy-negative GCA if they fulfilled the American College of Rheumatology 1990 criteria for the classification of GCA (Hunder GG, et al Arthritis Rheum 1990; 33:1122-8) despite having a negative TAB. Results: One hundred ninety Caucasian patients were diagnosed with GCA. Twenty-nine of them (15.3%) had a negative TAB. In these biopsy-negative patients, headache and polymyalgia rheumatica were frequent presenting symptoms. In contrast, jaw claudication, abnormal temporal artery on physical examination, and constitutional syndrome (asthenia, anorexia, and weight loss of 4 kg or more) were less common. They also had lower biologic markers of inflammation. The best predictive model of biopsy-proven GCA included a history of constitutional syndrome (OR = 6.1), an abnormal temporal artery on physical examination (OR = 3.2), and the presence of visual complications (OR = 4.9). Conclusions: In GCA, a subset of patients have a high likelihood of having a negative TAB. This subset seems to have less severe ischemic complications than that of biopsy-proven GCA. In patients without visual manifestations, abnormal temporal artery on examination or constitutional syndrome the risk of having an abnormal TAB is low. Semin Arthritis Rheum 30:249-256. Copyright © 2001 by W.B. Saunders Company

Section snippets

Patients and methods

We performed a retrospective study of the case records of all patients diagnosed with GCA in the Department of Medicine of the Hospital Xeral-Calde (Lugo, Spain) from January 1981 through December 1998. The Hospital Xeral-Calde is the only referral center for a mixed rural (60%) and urban population of approximately 250,000 people living in the Lugo region of northwestern Spain The main characteristics of the Lugo population have been reported previously 18, 19, 20, 21. All patients with

Results

One hundred ninety consecutive patients were diagnosed with GCA in the Lugo region from January 1981 to December 1998. One hundred fifty-three of them were diagnosed by rheumatologists and 37 by internal medicine staff physicians. Twenty-nine of the 190 patients (15.3%) had a negative TAB. The characteristics of patients with biopsy-proven GCA in the Lugo region have been described previously 18, 19, 20, 22, 23 and, for this reason, in this report we have undertaken a more detailed study of the

Discussion

In the Lugo region of northwestern Spain, temporal artery biopsy yield was intermediate between those observed in some Scandinavian countries, Rochester, Minnesota (USA), and Israel and those from other southern European countries 10, 12, 15, 16, 17, 33.

Attempts to correlate presenting features with TAB results have been undertaken previously. Hall et al found that jaw claudication and abnormal temporal artery on physical examination were more common in biopsy-proven than in biopsy-negative

Acknowledgements

The authors thank Drs Javier Alvarez-Ferreira and Fernando Bal (Pathology Division) for their valuable help in performing this study, and Drs Teresa Armada and Jaime Capella from the Medical Record Department of the Hospital Xeral-Calde for reviewing the medical records.

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    *

    Miguel A. Gonzalez-Gay, MD, PhD: Staff Physician, Rheumatology Division, Hospital Xeral-Calde, Lugo, Spain; Carlos Garcia-Porrua, MD, PhD: Staff Physician, Rheumatology Division, Hospital Xeral-Calde, Lugo. Spain; Javier Llorca, MD, PhD: Division of Preventive Medicine and Public Health, School of Medicine, University of Cantabria, Santander, Spain; Carmen Gonzalez-Louzao, MD: Resident, Rheumatology Division, Hospital Xeral-Calde, Lugo, Spain; Pilar Rodriguez-Ledo, MD: Family physician, Lugo, Spain.

    **

    Address reprint requests to Miguel A. Gonzalez-Gay, MD, PhD, Division of Rheumatology, Hospital Xeral-Calde, c/o Dr. Ochoa s/n, 27004 Lugo, Spain. E-mail: [email protected]

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