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Aged, Blepharoptosis diagnosis, C-Reactive Protein metabolism, Computed Tomography Angiography, Diplopia diagnosis, Female, Giant Cell Arteritis drug therapy, Glucocorticoids administration dosage, Humans, Intracranial Aneurysm drug therapy, Intracranial Aneurysm physiopathology, Prednisone administration dosage, Temporal Arteries drug effects, Visual Acuity, Giant Cell Arteritis diagnosis, Intracranial Aneurysm diagnosis, Oculomotor Nerve Diseases diagnosis, and Temporal Arteries pathology
Biomarkers blood, Biopsy, Blood Sedimentation, Follow-Up Studies, Giant Cell Arteritis diagnosis, Humans, ROC Curve, Retrospective Studies, Severity of Illness Index, Time Factors, C-Reactive Protein metabolism, Giant Cell Arteritis blood, and Temporal Arteries pathology
Objective: Temporal artery biopsy (TAB) is the gold standard for confirming the diagnosis of giant cell arteritis (GCA) when positive. However, the clinical significance of healed/healing (HH) arterial injury on TAB is not well understood. The purpose of this study was to evaluate the clinical significance of this finding on TAB by determining its association with seromarkers typically predictive of GCA.
Design: Single-centre, retrospective, investigational cohort study.
Participants: A total of 385 consecutive TABs for clinical suspicion of GCA between January 2009 and January 2016.
Methods: Elevations in erythrocyte sedimentation rate, C-reactive protein, and platelet count were compared between patients with negative TAB, GCA-positive TAB, and HH arterial injury using statistical trend testing. Odds ratios of seromarker elevations for HH arterial injury versus GCA were calculated.
Results: Seventy-six GCA-positive, 69 HH, and 240 negative TABs were identified. Mantel-Haenszel tests of trend indicated that platelets >400 000/µL (p < 0.01), erythrocyte sedimentation rate ≥50 mm/hr (p < 0.01), and C-reactive protein ≥24.5 mg/L (p < 0.01) occurred with intermediate frequency in the HH TAB group. The odds of HH TAB were 3.6 times greater (95% CI 1.5-8.5) with platelets >400 000/µL.
Conclusion: HH arterial injury is a heterogenous group that requires treatment in the appropriate clinical setting. From our study, we found that the HH group is intermediate between GCA-positive and GCA-negative biopsy with respect to serology markers only. Thrombocytosis is an independent predictor of HH TAB. With further studies, this marker may be considered when making treatment decisions. Further studies are required to better understand this entity.
(Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)
Aged, Giant Cell Arteritis complications, Humans, Leukemia, Lymphocytic, Chronic, B-Cell complications, Male, Biopsy methods, Giant Cell Arteritis diagnosis, Leukemia, Lymphocytic, Chronic, B-Cell diagnosis, and Temporal Arteries pathology
Antibodies, Antineutrophil Cytoplasmic blood, Biopsy, Churg-Strauss Syndrome drug therapy, Cyclophosphamide therapeutic use, Diagnosis, Differential, Drug Therapy, Combination, Glucocorticoids therapeutic use, Humans, Immunosuppressive Agents therapeutic use, Male, Middle Aged, Peroxidase blood, Prednisone therapeutic use, Churg-Strauss Syndrome diagnosis, Giant Cell Arteritis diagnosis, and Temporal Arteries pathology
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