title: Systematic review of the literature and a case report informing biopsy-proven giant cell arteritis (GCA) with normal C-reactive protein.
abstract: Giant cell arteritis (GCA) is a vasculitis of large- vessels. A markedly elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are characteristics of GCA, although temporal artery biopsy remains the gold standard for the diagnosis. We describe a case of biopsy-proven GCA showing a heavy infiltration of CD68 macrophages and CD3 T cells and with normal ESR and CRP levels at diagnosis. Key points (1) GCA may occur with normal ESR in a percentage of about 4 to 15 % (although the American College of Rheumatology classification criteria for giant cell arteritis include an ESR of 50 mm/h or more), while it can occur with normal ESR and normal CRP in a percentage of about 0.8 %. So, the clinical suspicion must be confirmed with a positive biopsy. (2) GCA patients with ESR >40 mm/h are characterized by higher incidence of headache and jaw claudication compared to patients with normal ESR. In our case, it occurred with normal ESR. (3) Color duplex ultrasonography is a noninvasive, easy, and inexpensive method for supporting a diagnosis of TA, with a high sensitivity and specificity. It can predict which patient will need TAB.
authors: Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
authors: A
authors: A
authors: Laria
authors: A
authors: A
authors: Zoli
authors: M
authors: M
authors: Bocci
authors: F
authors: F
authors: Castri
authors: F
authors: F
authors: Federico
authors: G F
authors: GF
authors: Ferraccioli
mesh_terms: D015703:Antigens, CD / Q000096:biosynthesis; D015214:Antigens, Differentiation, Myelomonocytic / Q000096:biosynthesis; D001706:Biopsy / Q000379:methods*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000096:biosynthesis* / Q000378:metabolism; D017252:CD3 Complex / Q000096:biosynthesis; D005260:Female; D013700:Giant Cell Arteritis / Q000503:physiopathology*; D006261:Headache / Q000097:blood; D006801:Humans; D015994:Incidence; D007568:Jaw / Q000503:physiopathology; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013601:T-Lymphocytes / Q000378:metabolism; D014463:Ultrasonography / Q000379:methods; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D002097:C-Reactive Protein; D017252:CD3 Complex; C067980:CD68 antigen, human; D000097382:CD68 Molecule