title: Comparison of histopathologic features, clinical symptoms, and erythrocyte sedimentation rates in biopsy-positive temporal arteritis.
abstract: OBJECTIVE
  To compare the histopathologic stage of temporal arteritis observed in biopsy-positive specimens with clinical symptoms and erythrocyte sedimentation rates (ESR). Also, to compare the degree of involvement of biopsies from the right versus left side in patients receiving bilateral biopsies.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Thirty-seven patients, 30 of whom received unilateral biopsies and 7 of whom had bilateral biopsies.
  
  
  METHODS
  Biopsy specimens were reviewed and assigned a severity score on the basis of the presence of histopathologic features known to be associated with temporal arteritis. The charts for these patients were then reviewed, and patients' clinical symptoms were classified by use of an ordinal scale of severity. The first level of severity entailed headache or superficial pain without any other symptoms. The second level included constitutional symptoms such as weight loss, anorexia, fever, and fatigue. The third level of severity included the presence of visual manifestations. The ESR values were also recorded from patients' charts and examined as a continuous variable.
  
  
  RESULTS
  There is a statistically significant correlation between histopathologic stage of disease observed in biopsy specimens and clinical presentation. (P < 0.0001) The biopsy severity did not correlate significantly with ESR values (P = 0.09). There was significant variation of ESR values among the 3 levels of clinical severity (analysis of variance test yielded P = 0.04). By use of the independent samples t test, we found that mean ESR values from patients with constitutional symptoms and visual symptoms were not statistically different (P nonsignificant), yet patients with only headache/superficial tenderness had significantly lower ESR values than the rest of our patient population (P = 0.009). Last, we found that the mean difference in biopsy severity was significantly above zero (P < 0.001) when comparing simultaneous bilateral biopsy specimens.
  
  
  CONCLUSIONS
  Because of the strong correlation between biopsy severity and clinical presentation, this study supports the use of temporal artery biopsy to identify patients' risk for complications caused by temporal arteritis. Furthermore, this study indicates that ESR may be more elevated in patients with constitutional or visual symptoms than in patients with headache or scalp pain. Finally, the pathologic grade of the disease may differ significantly from 1 side to the contralateral side.
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut, USA. Vicente.Diaz@Yale.edu
authors.forename: Vicente A
authors.initials: VA
authors.lastname: Diaz
authors.forename: Brian M
authors.initials: BM
authors.lastname: DeBroff
authors.forename: John
authors.initials: J
authors.lastname: Sinard
mesh_terms: D001706:Biopsy; D001799:Blood Sedimentation; D013700:Giant Cell Arteritis / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D013699:Temporal Arteries / Q000473:pathology*