Does temporal artery biopsy influence the management of temporal arteritis?
BACKGROUND
Temporal arteritis (TA) is the commonest form of primary vasculitis. Symptoms are variable, and therefore the diagnosis (or exclusion) of TA is often difficult. Surgeons are frequently asked to perform a temporal artery biopsy (TAB), but whether the histological result actually influences clinical management is unclear.


OBJECTIVE
To assess whether, in routine clinical practice, a TAB affects clinical decision-making in patients with suspected TA.


METHODS
Retrospective audit.


METHODS
All patients who underwent a TAB in a single hospital over a 2-year period were identified. This included patients referred from different specialist departments. Individual patient records were examined to document the TAB result, and in particular, the timings of commencement and discontinuation of corticosteroid therapy.


RESULTS
A total of 44 patients were included. TAB was positive in seven patients and negative in 37. In 31, there was no change in their clinical management despite a negative biopsy result: 18 continued with corticosteroids for >6 months with a clinical diagnosis of TA, and in 13 patients a decision to stop steroids, or an alternative diagnosis, was made before the biopsy result was known.


CONCLUSIONS
In this retrospective study, only a small number of TABs provided positive histological confirmation of TA, and in most patients undergoing TAB, there was little evidence that clinical decision-making with respect to corticosteroid therapy was influenced by the TAB result.
Lenton
J
J
Department of Vascular Surgery, Derby Hospitals NHS Foundation Trust, UK.
Donnelly
R
R
Nash
J R
JR
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001706:Biopsy / Q000379:methods; D004739:England; D013700:Giant Cell Arteritis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000473:pathology*
D000305:Adrenal Cortex Hormones