title: Association between histological features in temporal artery biopsies and clinical features of patients with giant cell arteritis.
abstract: BACKGROUND
  In most cases of giant cell arteritis (GCA) the diagnosis is confirmed by temporal artery biopsy. Aside from the diagnostic purpose, histological parameters may serve as prognostic markers.
  
  
  OBJECTIVE
  To review positive temporal artery biopsies ofGCA in an attempt to correlate various histological parameters with clinical features, disease complications and outcome.
  
  
  METHODS
  Positive biopsies from 65 GCA patients were randomly selected for review by a single pathologist. In each biopsy the following parameters were scored: intensity and location of the inflammatory infiltrate, presence of giant cells and other cell types, fragmentation and calcification of the internal elastic lamina, intimal thickening, and presence of luminal thrombus. Clinical data were obtained from the patients' charts. Intensity of the initial systemic inflammatory reaction (ISIR) at the time of diagnosis was scored by the presence of five parameters: fever, anemia, thrombocytosis, leukocytosis, and sedimentation rate >100 mm/hr.
  
  
  RESULTS
  In cases with bilateral positive biopsy (n=27), there was good correlation between the two sides regarding intensity of inflammation (r= 0.65, P< 0.001), location of the infiltrate (r= 0.7, P< 0.001), degree of intimal thickening (r= 0.54, P 0.001), and presence of giant cells (r= 0.83, P< 0.001). The rate of corticosteroid discontinuation tended to be quicker in patients with inflammatory infiltrates confined mainly to the adventitia, but other histological parameters did not affect this rate.
  
  
  CONCLUSIONS
  Inflammatory infiltrates confined to the adventitia were associated with more neuro-ophthalmic ischemic manifestations, weak/moderate ISIR at the time of diagnosis, and faster rate of corticosteroid discontinuation. No association was found between other temporal artery biopsy histological parameters and clinical features of GCA patients.
authors.affiliation: Departments of lnternal Medicine-Rheumatology, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel gbreuer@szmc.org.il
authors.forename: Gabriel S
authors.initials: GS
authors.lastname: Breuer
authors.forename: Ronit
authors.initials: R
authors.lastname: Nesher
authors.forename: Konstantin
authors.initials: K
authors.lastname: Reinus
authors.forename: Gideon
authors.initials: G
authors.lastname: Nesher
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods / Q000706:statistics & numerical data; D001799:Blood Sedimentation; D005260:Female; D013700:Giant Cell Arteritis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D015726:Giant Cells / Q000473:pathology; D006652:Histological Techniques; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D011897:Random Allocation; D012044:Regression Analysis; D013223:Statistics as Topic; D063189:Symptom Assessment / Q000379:methods / Q000706:statistics & numerical data; D013699:Temporal Arteries / Q000473:pathology*; D017539:Tunica Intima / Q000473:pathology*