title: Is intimal hyperplasia a marker of neuro-ophthalmic complications of giant cell arteritis?
abstract: OBJECTIVE
  The ischaemic complications of giant cell arteritis (GCA) such as blindness and stroke may result from luminal narrowing of the affected arteries. This study focuses on the association between the severity of intimal proliferation on temporal artery biopsy (TAB) histology and neuro-ophthalmic complications (NOCs) of GCA.
  
  
  METHODS
  We identified 30 cases of biopsy-proven temporal arteritis. One histopathologist (blinded to the clinical details) evaluated the TAB specimens and categorized the degree of maximum stenosis due to intimal hyperplasia into four grades: grade 1 is <50% luminal occlusion due to intimal hyperplasia, grade 2 is 50-75%, grade 3 is >75% and grade 4 is complete luminal occlusion. A second histopathologist (also blinded to the clinical details) independently evaluated the TAB specimens using the same grading system. The NOCs in these patients were noted after a case record review.
  
  
  RESULTS
  Of the 30 patients, 12 had NOC-10 with eye complications (complete visual loss, anterior ischaemic neuropathy, visual field defects), one patient had cerebral infarcts and one had both cerebral infarcts and vision loss. There was evidence for a statistically significant trend of NOC associated with higher intimal hyperplasia scores (P = 0.001). The scores of the histopathologists agreed for 23 (77%) patients and differed by 1 category for the remaining 7 (kappa-statistic 0.88).
  
  
  CONCLUSIONS
  Our study suggests that the degree of intimal hyperplasia on TAB histology (routinely available to all hospital units) seems to be closely associated with NOCs of GCA. The study highlights the possible prognostic as well as diagnostic role of the biopsy. We feel that intimal hyperplasia noted in biopsy specimens may help us in the risk stratification of GCA patients and targeting of appropriate and novel therapies.
authors.affiliation: Department of Rheumatology, Southend University Hospital, Prittlewell Chase, Westcliff on Sea, Essex SS0 0RY, UK.
authors.forename: D
authors.initials: D
authors.lastname: Makkuni
authors.forename: A
authors.initials: A
authors.lastname: Bharadwaj
authors.forename: K
authors.initials: K
authors.lastname: Wolfe
authors.forename: S
authors.initials: S
authors.lastname: Payne
authors.forename: A
authors.initials: A
authors.lastname: Hutchings
authors.forename: B
authors.initials: B
authors.lastname: Dasgupta
mesh_terms: D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000473:pathology; D001706:Biopsy; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology; D013700:Giant Cell Arteritis / Q000150:complications* / Q000473:pathology*; D006801:Humans; D006965:Hyperplasia; D012720:Severity of Illness Index; D013699:Temporal Arteries / Q000473:pathology*; D017539:Tunica Intima / Q000473:pathology*; D014786:Vision Disorders / Q000209:etiology* / Q000473:pathology