Temporal arteritis diagnostic study of choice: Difference between revisions

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=== Study of choice ===
=== Study of choice ===
*Temporal artery biopsy is the gold standard test for the diagnosis of temporal arteritis.
*Temporal artery biopsy is the gold standard test for the diagnosis of temporal arteritis.
* The following result of temporal artery biopsy is confirmatory of temporal arteritis:
* The following result of temporal artery biopsy is confirmatory of temporal arteritis:<ref name="pmid7728064">{{cite journal| author=Pountain G, Hazleman B| title=ABC of rheumatology. Polymyalgia rheumatica and giant cell arteritis. | journal=BMJ | year= 1995 | volume= 310 | issue= 6986 | pages= 1057-9 | pmid=7728064 | doi= | pmc=2549437 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7728064  }} </ref><ref name="pmid10817557">{{cite journal| author=Weyand CM, Fulbright JW, Hunder GG, Evans JM, Goronzy JJ| title=Treatment of giant cell arteritis: interleukin-6 as a biologic marker of disease activity. | journal=Arthritis Rheum | year= 2000 | volume= 43 | issue= 5 | pages= 1041-8 | pmid=10817557 | doi=10.1002/1529-0131(200005)43:5<1041::AID-ANR12>3.0.CO;2-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10817557  }} </ref>
** Result 1
**Skip lesions and normal intervening segments
** Result 2
**Intimal thickening, with prominent [[cellular infiltration]]
**[[Lymphocyte|Lymphocytes]] in the internal or external elastic lamina or [[adventitia]]
**Areas of [[necrosis]] may be present in the [[Artery|arterial]] wall
**[[Granuloma|Granulomas]] containing [[Multinucleate|multinucleated]] [[Histiocyte|histiocytic]] and foreign body [[Macrophage|giant cells]], [[T helper cell|helper T-cell]] [[Lymphocyte|lymphocytes]], [[Plasma cell|plasma cells]], and [[Fibroblast|fibroblasts]]<ref name="pmid23523078">{{cite journal| author=Liozon E, Ly KH, Robert PY| title=[Ocular complications of giant cell arteritis]. | journal=Rev Med Interne | year= 2013 | volume= 34 | issue= 7 | pages= 421-30 | pmid=23523078 | doi=10.1016/j.revmed.2013.02.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23523078  }} </ref>
 
* The temporal artery biopsy should be performed when:
* The temporal artery biopsy should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** The patient presented with symptoms of temporal headache above age 50 years,and visual problems.  
** A positive [test] is detected in the patient.
*Temporal arteritis is mainly diagnosed based on clinical presentation.
*Temporal arteritis is mainly diagnosed based on clinical presentation.
* Investigations:
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of temporal arteritis, the temporal artery biopsy is the most specific test for the diagnosis.<ref name="pmid17251465">{{cite journal| author=Niederkohr RD, Levin LA| title=A Bayesian analysis of the true sensitivity of a temporal artery biopsy. | journal=Invest Ophthalmol Vis Sci | year= 2007 | volume= 48 | issue= 2 | pages= 675-80 | pmid=17251465 | doi=10.1167/iovs.06-1106 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17251465  }} </ref>
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
 
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
*Clinical features of severity correlate with the [[Histopathology|histopathological]] changes on the [[Superficial temporal artery|temporal artery]] [[biopsy]].<ref name="pmid7242167">{{cite journal| author=Moya Mir MS, Martín Jiménez T, Barbadillo R, Martín Martín F, Sánchez Ariño A, Magnani E| title=[Giant cell arteritis: diagnostic value of a second biopsy of the temporal artery (author's transl)]. | journal=Med Clin (Barc) | year= 1981 | volume= 76 | issue= 10 | pages= 452-3 | pmid=7242167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7242167  }} </ref>
*A positive [[biopsy]] after initiation of [[steroid]] treatment vary from 10% after 1 week to 86% after 4 or more weeks of treatment.<ref name="pmid7728064">{{cite journal| author=Pountain G, Hazleman B| title=ABC of rheumatology. Polymyalgia rheumatica and giant cell arteritis. | journal=BMJ | year= 1995 | volume= 310 | issue= 6986 | pages= 1057-9 | pmid=7728064 | doi= | pmc=2549437 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7728064  }} </ref><ref name="pmid11973248">{{cite journal| author=Ray-Chaudhuri N, Kiné DA, Tijani SO, Parums DV, Cartlidge N, Strong NP et al.| title=Effect of prior steroid treatment on temporal artery biopsy findings in giant cell arteritis. | journal=Br J Ophthalmol | year= 2002 | volume= 86 | issue= 5 | pages= 530-2 | pmid=11973248 | doi= | pmc=1771122 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11973248  }} </ref>
*Most physicians with high clinical suspicion despite an initial negative [[biopsy]] would still recommend a second contralateral [[biopsy]], given the consequences of a missed [[diagnosis]] of temporal arteritis.<ref name="pmid11567973">{{cite journal| author=Riordan-Eva P, Landau K, O'Day J| title=Temporal artery biopsy in the management of giant cell arteritis with neuro-ophthalmic complications. | journal=Br J Ophthalmol | year= 2001 | volume= 85 | issue= 10 | pages= 1248-51 | pmid=11567973 | doi= | pmc=1723724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11567973  }} </ref>
*Risks of [[Superficial temporal artery|temporal artery]] [[biopsy]] are temporary or permanent damage to the [[Temporal branches of the facial nerve|temporal branch of the facial nerve]], [[infection]], [[bleeding]], [[hematoma]], and [[dehiscence]].
 
====Video====
{{#ev:youtube|yomjRscIxfE}}


===== Diagnostic results =====
===== Diagnostic results =====
The following result of temporal artery biopsy is confirmatory of temporal arteritis:
The following result of temporal artery biopsy is confirmatory of temporal arteritis:
* Result 1
* Skip lesions and normal intervening segments
* Result 2
* Intimal thickening, with prominent [[cellular infiltration]]
 
* [[Lymphocyte|Lymphocytes]] in the internal or external elastic lamina or [[adventitia]]
===== Sequence of Diagnostic Studies =====
* Areas of [[necrosis]] may be present in the [[Artery|arterial]] wall
The temporal artery biopsy should be performed when:
* [[Granuloma|Granulomas]] containing [[Multinucleate|multinucleated]] [[Histiocyte|histiocytic]] and foreign body [[Macrophage|giant cells]], [[T helper cell|helper T-cell]] [[Lymphocyte|lymphocytes]], [[Plasma cell|plasma cells]], and [[Fibroblast|fibroblasts]]<ref name="pmid23523078">{{cite journal| author=Liozon E, Ly KH, Robert PY| title=[Ocular complications of giant cell arteritis]. | journal=Rev Med Interne | year= 2013 | volume= 34 | issue= 7 | pages= 421-30 | pmid=23523078 | doi=10.1016/j.revmed.2013.02.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23523078  }} </ref>
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.


=== Diagnostic Criteria ===
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*There are no established criteria for the diagnosis of temporal arteritis.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


==References==
==References==
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[[Category:Rheumatology]]
[[Category:Ophthalmology]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Disease]]

Latest revision as of 19:09, 16 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

The gold standard for diagnosing temporal arteritis is biopsy, which involves removing of a small part of the vessel and examining it microscopically for giant cells infiltrating the tissue. Since the blood vessels are involved in a patchy pattern, there may be unaffected areas on the vessel and the biopsy might have been taken from these parts. So, a negative result does not definitely rule out the diagnosis. Findings diagnostic of temporal arteritis include skip lesions and normal intervening segments, intimal thickening, with prominent cellular infiltration, lymphocytes in the internal or external elastic lamina or adventitia, areas of necrosis may be present in the arterial wall, granulomas containing multinucleated histiocytic and foreign body giant cells, helper T-cell lymphocytes, plasma cells, and fibroblasts. Risks of temporal artery biopsy are temporary or permanent damage to the temporal branch of the facial nerve, infection, bleeding, hematoma, and dehiscence.

Diagnostic Study of Choice

Study of choice

  • The temporal artery biopsy should be performed when:
    • The patient presented with symptoms of temporal headache above age 50 years,and visual problems.
  • Temporal arteritis is mainly diagnosed based on clinical presentation.
  • Investigations:
    • Among patients who present with clinical signs of temporal arteritis, the temporal artery biopsy is the most specific test for the diagnosis.[4]

Video

{{#ev:youtube|yomjRscIxfE}}

Diagnostic results

The following result of temporal artery biopsy is confirmatory of temporal arteritis:

Diagnostic Criteria

  • There are no established criteria for the diagnosis of temporal arteritis.

References

  1. ↑ 1.0 1.1 Pountain G, Hazleman B (1995). "ABC of rheumatology. Polymyalgia rheumatica and giant cell arteritis". BMJ. 310 (6986): 1057–9. PMC 2549437. PMID 7728064.
  2. ↑ Weyand CM, Fulbright JW, Hunder GG, Evans JM, Goronzy JJ (2000). "Treatment of giant cell arteritis: interleukin-6 as a biologic marker of disease activity". Arthritis Rheum. 43 (5): 1041–8. doi:10.1002/1529-0131(200005)43:5<1041::AID-ANR12>3.0.CO;2-7. PMID 10817557.
  3. ↑ 3.0 3.1 Liozon E, Ly KH, Robert PY (2013). "[Ocular complications of giant cell arteritis]". Rev Med Interne. 34 (7): 421–30. doi:10.1016/j.revmed.2013.02.030. PMID 23523078.
  4. ↑ Niederkohr RD, Levin LA (2007). "A Bayesian analysis of the true sensitivity of a temporal artery biopsy". Invest Ophthalmol Vis Sci. 48 (2): 675–80. doi:10.1167/iovs.06-1106. PMID 17251465.
  5. ↑ Moya Mir MS, Martín Jiménez T, Barbadillo R, Martín Martín F, Sánchez Ariño A, Magnani E (1981). "[Giant cell arteritis: diagnostic value of a second biopsy of the temporal artery (author's transl)]". Med Clin (Barc). 76 (10): 452–3. PMID 7242167.
  6. ↑ Ray-Chaudhuri N, Kiné DA, Tijani SO, Parums DV, Cartlidge N, Strong NP; et al. (2002). "Effect of prior steroid treatment on temporal artery biopsy findings in giant cell arteritis". Br J Ophthalmol. 86 (5): 530–2. PMC 1771122. PMID 11973248.
  7. ↑ Riordan-Eva P, Landau K, O'Day J (2001). "Temporal artery biopsy in the management of giant cell arteritis with neuro-ophthalmic complications". Br J Ophthalmol. 85 (10): 1248–51. PMC 1723724. PMID 11567973.

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