title: Steroid use is associated with clinically irrelevant biopsies in patients with suspected giant cell arteritis.
abstract: Temporal artery biopsy (TAB) is the diagnostic gold standard for giant cell arteritis (GCA). GCA is treated by high-dose corticosteroids. In cases of high clinical suspicion, steroids may be administrated despite negative TAB, making TAB clinically irrelevant. We assessed the role of  TAB in clinical decision-making in patients with suspected GCA and to identify factors associated with clinically irrelevant TAB. Charts of patients who underwent TAB from 2005 to 2010 were reviewed for clinical parameters potentially associated with GCA and clinically irrelevant TAB. We studied  143 patients with 99 negative (69%), 34 positive (24%), and 10 undefined (7%) TABs. Eventually 26 patients (18% of the entire cohort and 26% of the patients with a negative TAB) received steroid treatment for GCA despite negative TAB. The start of steroid treatment before TAB was associated  with clinically irrelevant TABs. If clinical suspicion of GCA is high, a TAB can be considered clinically irrelevant.
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. i.thomassen@live.nl
authors.forename: Irene
authors.initials: I
authors.lastname: Thomassen
authors.forename: Avalon N
authors.initials: AN
authors.lastname: den Brok
authors.forename: Constantijn Jam
authors.initials: CJ
authors.lastname: Konings
authors.forename: Simon W
authors.initials: SW
authors.lastname: Nienhuijs
authors.forename: Marcel C G
authors.initials: MC
authors.lastname: van de Poll
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D016001:Confidence Intervals; D016208:Databases, Factual; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D013700:Giant Cell Arteritis / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013699:Temporal Arteries / Q000187:drug effects* / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones