The effect of clinical features and glucocorticoids on biopsy findings in giant cell arteritis
(2016) In BMC Musculoskeletal Disorders 17(1).- Abstract
Background: To investigate the effect of baseline clinical characteristics and glucocorticoid treatment on temporal artery biopsy (TAB) findings in patients with giant cell arteritis (GCA). Methods: Individuals who developed GCA after inclusion in two population-based health surveys were identified through linkage to the local and the national patient registers. In addition, other patients diagnosed with GCA at the Departments of Internal Medicine and Rheumatology at an area hospital were included. A structured review of medical records and TAB pathology reports was performed. The presence or absence of giant cells, granuloma, fragmented internal elastic lamina, fibrosis and grade of inflammatory infiltrates were recorded. Results: In... (More)
Background: To investigate the effect of baseline clinical characteristics and glucocorticoid treatment on temporal artery biopsy (TAB) findings in patients with giant cell arteritis (GCA). Methods: Individuals who developed GCA after inclusion in two population-based health surveys were identified through linkage to the local and the national patient registers. In addition, other patients diagnosed with GCA at the Departments of Internal Medicine and Rheumatology at an area hospital were included. A structured review of medical records and TAB pathology reports was performed. The presence or absence of giant cells, granuloma, fragmented internal elastic lamina, fibrosis and grade of inflammatory infiltrates were recorded. Results: In 183 cases with a confirmed clinical diagnosis of GCA, 139 were biopsied after start of glucocorticoids (median treatment duration 3 days; interquartile range 2-5). Patients with a positive TAB (77 %) had significantly higher C-reactive protein (CRP; p = 0.007) and erythrocyte sedimentation rate (ESR; p = 0.03) at the time of clinical diagnosis. A positive TAB tended to more common in women, but there was no difference in the proportion of patients with polymyalgia rheumatica or visual symptoms. Patients biopsied before or on the same day as initial treatment where more likely than those biopsied 1-3 days after treatment start to have positive biopsy [odds ratio (OR) 2.86; 95 % CI 1.06-7.70] as well as inflammatory infiltrates (OR 3.30; 95 % CI 1.15-9.49). There was no significant difference in the proportions of a fragmented internal lamina (p = 0.86), giant cells (p = 0. 10), granuloma (p = 0.19), minor inflammatory infiltrates (p = 0.47), major inflammatory infiltrates (p = 0.09), or overall positive biopsy (p = 0.17) report by treatment duration comparing: ≤ 0 days, 1-3 days, 4-6 days, 7-28 days. Among those biopsied 7-28 days after start of treatment, 80 % of TABs were positive, and histopathology features were not substantially different from those biopsied after shorter glucocorticoid treatment. Conclusion: Biopsies were more likely to be positive and have characteristic histopathologic features in patients with high CRP and ESR, and prior to start of corticosteroid treatment TABs taken 1-4 weeks after initiation of glucocorticoid treatment reveal changes consistent with GCA and therefore still yields clinically useful information for the diagnosis.
(Less)
- author
- Jakobsson, Karin LU ; Jacobsson, Lennart LU ; Mohammad, Aladdin J. LU ; Nilsson, Jan Åke LU ; Warrington, Kenneth ; Matteson, Eric L. and Turesson, Carl LU
- organization
- publishing date
- 2016
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Giant cell arteritis, Glucocorticoid treatment, Histopathology findings, Temporal artery biopsy
- in
- BMC Musculoskeletal Disorders
- volume
- 17
- issue
- 1
- article number
- 363
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:27558589
- wos:000395020700004
- scopus:85007518285
- ISSN
- 1471-2474
- DOI
- 10.1186/s12891-016-1225-2
- language
- English
- LU publication?
- yes
- id
- e76b72b3-5cf2-42f6-adf5-1fc2d5cc042f
- date added to LUP
- 2017-01-19 10:11:26
- date last changed
- 2025-01-12 19:42:32
@article{e76b72b3-5cf2-42f6-adf5-1fc2d5cc042f, abstract = {{<p>Background: To investigate the effect of baseline clinical characteristics and glucocorticoid treatment on temporal artery biopsy (TAB) findings in patients with giant cell arteritis (GCA). Methods: Individuals who developed GCA after inclusion in two population-based health surveys were identified through linkage to the local and the national patient registers. In addition, other patients diagnosed with GCA at the Departments of Internal Medicine and Rheumatology at an area hospital were included. A structured review of medical records and TAB pathology reports was performed. The presence or absence of giant cells, granuloma, fragmented internal elastic lamina, fibrosis and grade of inflammatory infiltrates were recorded. Results: In 183 cases with a confirmed clinical diagnosis of GCA, 139 were biopsied after start of glucocorticoids (median treatment duration 3 days; interquartile range 2-5). Patients with a positive TAB (77 %) had significantly higher C-reactive protein (CRP; p = 0.007) and erythrocyte sedimentation rate (ESR; p = 0.03) at the time of clinical diagnosis. A positive TAB tended to more common in women, but there was no difference in the proportion of patients with polymyalgia rheumatica or visual symptoms. Patients biopsied before or on the same day as initial treatment where more likely than those biopsied 1-3 days after treatment start to have positive biopsy [odds ratio (OR) 2.86; 95 % CI 1.06-7.70] as well as inflammatory infiltrates (OR 3.30; 95 % CI 1.15-9.49). There was no significant difference in the proportions of a fragmented internal lamina (p = 0.86), giant cells (p = 0. 10), granuloma (p = 0.19), minor inflammatory infiltrates (p = 0.47), major inflammatory infiltrates (p = 0.09), or overall positive biopsy (p = 0.17) report by treatment duration comparing: ≤ 0 days, 1-3 days, 4-6 days, 7-28 days. Among those biopsied 7-28 days after start of treatment, 80 % of TABs were positive, and histopathology features were not substantially different from those biopsied after shorter glucocorticoid treatment. Conclusion: Biopsies were more likely to be positive and have characteristic histopathologic features in patients with high CRP and ESR, and prior to start of corticosteroid treatment TABs taken 1-4 weeks after initiation of glucocorticoid treatment reveal changes consistent with GCA and therefore still yields clinically useful information for the diagnosis.</p>}}, author = {{Jakobsson, Karin and Jacobsson, Lennart and Mohammad, Aladdin J. and Nilsson, Jan Åke and Warrington, Kenneth and Matteson, Eric L. and Turesson, Carl}}, issn = {{1471-2474}}, keywords = {{Giant cell arteritis; Glucocorticoid treatment; Histopathology findings; Temporal artery biopsy}}, language = {{eng}}, number = {{1}}, publisher = {{BioMed Central (BMC)}}, series = {{BMC Musculoskeletal Disorders}}, title = {{The effect of clinical features and glucocorticoids on biopsy findings in giant cell arteritis}}, url = {{http://dx.doi.org/10.1186/s12891-016-1225-2}}, doi = {{10.1186/s12891-016-1225-2}}, volume = {{17}}, year = {{2016}}, }