Abstract
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.