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Inflammatory markers but not symptoms are a strong predictor of temporal artery biopsy outcome – the Portsmouth experience
Author(s) -
Meredith P.R.,
Sepetis A.,
Balendra S.,
Jawed M.,
Lockwood A.J.,
Maclean H.
Publication year - 2017
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2017.03185
Subject(s) - medicine , biopsy , gastroenterology , giant cell arteritis , claudication , arteritis , correlation , surgery , vasculitis , vascular disease , mathematics , arterial disease , geometry , disease
Purpose To investigate the correlation of biopsy proven temporal arteritis with clinical symptoms and inflammatory markers. Methods Retrospective study of all patients (n = 89) referred for temporal artery biopsy ( TAB ) over a 30‐month period. Ten patients were excluded due to inconclusive biopsy or insufficient data. Correlation of presenting symptom (localised headache LH , jaw claudication JC , pain over temporal artery PTA , constitutional symptoms CS ) and inflammatory marker level ( ESR , CRP ) with histological outcome (presence of giant cells) were assessed using a two‐tailed unpaired t ‐test. Results 50 cases had a negative (−ve) biopsy result and 29 positive (+ve). Mean age ( SD ) for each group was 71 yrs (10) and 77 yrs (6) respectively. No significant correlation was found between presenting symptom and biopsy result (−ve:+ve LH 88%:79%, PTA 46%:62%, CS 40%:59%) except for jaw claudication (36%:62%, p < 0.05). Inflammatory marker result was found to significantly correlate with biopsy outcome. Mean ESR ( SD ) was 23 (21) in the −ve and 34 (24) in the +ve (p < 0.05) and mean CRP ( SD ) was 33 (40) in the −ve and 98 (81) in the +ve group, (p < 0.001). Mean ESR + CRP ( SD ) was 55 (52) in the −ve and 132 (87) in the +ve (p < 0.0001). There were no significant differences in duration of steroid treatment prior to TAB or time to TAB between the two groups. One patient had normal ESR and CRP with a positive biopsy result.Treatment with steroids was continued for 48% of patients with −ve biopsy on clinical grounds. Conclusions Elevated ESR and CRP are strongly predictive of positive TAB outcome. Combining ESR + CRP increases the significance of the correlation. Further studies with larger patient numbers may identify an appropriate cut‐off level which, combined with age and clinical features, may provide a clinical score to aid decision making regarding which patients require TAB .