Temporal Artery Biopsy

Question 1

Patient population commonly affected by giant cell (aka temporal) arteritis?

Answer 1

White women >50 y/o, often Scandinavian or Northern European descent, hx of smoking and atheromatous disease increase risk in women, HLA-DR4+

Question 2

The inflammatory process of temporal arteries typically involves the ___ and its extracranial branches, of which the ___ is specifically affected.

Answer 2

Aorta; superficial temporal artery

Question 3

Presentation of giant cell arteritis?

Answer 3

Prodrome: constitutional symptoms (headache, fever, malaise, myalgias)
May be diagnosed with coexisting polymyalgia rheumatica (HLA-related assocation may exist)
Complications: visual alterations including blindness and mural weakness, resulting in acute aortic dissection; ischemic optic neuritis resulting in partial or complete blindness occurs in up to 40%
Jaw claudication and temporal artery tenderness

Question 4

Dx gold standard?

Answer 4

Temporal artery biopsy

Question 5

Classic histologic findings of temporal artery biopsy?

Answer 5

Multinucleated giant cells with dense perivascular inflammatory infiltrate

Question 6

Management of giant cell arteritis?

Answer 6

Corticosteroids (start at 60 mg prednisone, continue for 4 weeks or until symptoms improve, slowly taper over 9-12 months)

Aspirin (significantly decreased incidence of visual loss and cerebral vascular events)

Anti-TNF-alpha if refractory

Question 7

Pathogenic mechanism of giant cell?

Answer 7

Unknown; current understanding implicates a foreign antigen in a cascade of events resulting in arterial inflammation and luminal occlusion

Question 8

Classification criteria from the ACR?

Answer 8

Age >50
New-onset localized headaches
Tenderness or decreased pulse of the temporal artery
ESR > 50
Biopsy demonstrating above findings
(3/5 findings)

Question 9

Lab findings in GCA?

Answer 9

CBC - elevated platelet count, anemia of chronic disease
ESR often elevated (can be normal)
CRP elevated (variable)
IL-6 elevated (correlates with severity)
Liver function may show elevated alk phos

Question 10

U/S of the temporal arteries in GCA?

Answer 10

Hypoechoic ring around arteries (halo sign) when inflamed; good PPV compared to biopsy