title: Temporal artery biopsy: a diagnostic tool for systemic necrotizing vasculitis. French Vasculitis Study Group.
abstract: OBJECTIVE
  To describe the clinical, biologic, and histologic features of temporal artery biopsy (TAB)-localized systemic necrotizing vasculitides (SNV), and to assess their frequency among elderly patients undergoing TAB for suspected giant cell (temporal) arteritis (GCA).
  
  
  METHODS
  The frequency of a TAB localization of SNV was prospectively assessed in a multicenter study of elderly patients undergoing TAB for suspected GCA. All patients with SNV fulfilling the American College of Rheumatology criteria for a specific vasculitic syndrome and with evidence of vasculitis on TAB were included in a retrospective, descriptive study.
  
  
  RESULTS
  SNV was diagnosed based on the TAB in 1.4% of the patients with suspected GCA and in 4.5% of the positive (inflamed) TAB specimens. We retrospectively selected 27 patients (18 female, 9 male; mean +/- SD age 62+/-15 years, range 22-79 years) with SNV and TAB-localized vasculitis. Only 2 of these patients were known to have SNV before TAB localization. Twenty-two patients (81%) had cephalic symptoms, including jaw claudication in 33%, clinically abnormal temporal arteries in 33%, and neuro-ophthalmologic symptoms in 11%. All patients had systemic symptoms suggestive of SNV and histologically proven NV in the TAB specimens (70%) or elsewhere in other biopsy sites (74%). Abnormal biologic results suggestive of SNV were present in 17 patients (63%). For 4 patients, the TAB-documented involvement led to initial misdiagnoses of GCA, and systemic manifestations that developed under steroid therapy revealed the correct diagnosis. The final diagnoses of the patients were polyarteritis nodosa (PAN) (n = 11), Churg-Strauss syndrome (n = 6), micropoly-angiitis (n = 3), Wegener's granulomatosis (n = 3), hepatitis B virus-related PAN (n = 2), hepatitis C virus-related cryoglobulinemic vasculitis (n = 1), and rheumatoid vasculitis (n = 1).
  
  
  CONCLUSIONS
  TAB-localized SNV presents a major diagnostic dilemma because it can mimic GCA. Careful analysis of clinical, biologic, and histologic data should lead to the correct diagnosis and help guide the clinician's choice of appropriate therapy.
authors.affiliation: Service de Médecine Interne, La Salpêtrière, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Généreau
authors.forename: O
authors.initials: O
authors.lastname: Lortholary
authors.forename: M A
authors.initials: MA
authors.lastname: Pottier
authors.forename: U
authors.initials: U
authors.lastname: Michon-Pasturel
authors.forename: T
authors.initials: T
authors.lastname: Ponge
authors.forename: B
authors.initials: B
authors.lastname: de Wazières
authors.forename: E
authors.initials: E
authors.lastname: Liozon
authors.forename: L
authors.initials: L
authors.lastname: Pinède
authors.forename: E
authors.initials: E
authors.lastname: Hachulla
authors.forename: P
authors.initials: P
authors.lastname: Roblot
authors.forename: J H
authors.initials: JH
authors.lastname: Barrier
authors.forename: S
authors.initials: S
authors.lastname: Herson
authors.forename: L
authors.initials: L
authors.lastname: Guillevin
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000473:pathology*; D016896:Treatment Outcome; D014657:Vasculitis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones