temporal artery biopsy in GCA

Q: 62 years old Caucasian female of Scandinavian descent with past history of polymyalgia rheumatica is recovering in ICU from community-acquired pneumonia. She complained of loss of vision in one eye with ipsilateral jaw claudication. Giant Cell Arteritis (GCA) is diagnosed, and steroid treatment is promptly initiated. Temporal artery biopsy is required to be performed within 24-48 hours? 

A) True

B) False

Answer: B

Initial temporal artery biopsy in suspected cases of GCA can be performed within two to four weeks of treatment. The vital management is to commence glucocorticoid once the diagnosis is suspected. An initial biopsy can be ipsilateral. At least 1 cm of length is recommended for the sample. Biopsy of the contralateral side should be considered if the unilateral biopsy and other workup for temporal arteritis and large vessel vasculitis remain negative but the clinical suspicion stays high.

The biopsy can be delayed for preparation as the resolution of the inflammatory infiltrate occurs slow, and the histopathologic evidence stays for about 2-4 weeks despite steroid therapy. Said that the earlier the biopsy is done, the yield would be higher.

#vasculitis

#rheumatology

References:

1. Achkar AA, Lie JT, Hunder GG, et al. How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med 1994; 120:987.

2. Narváez J, Bernad B, Roig-Vilaseca D, et al. Influence of previous corticosteroid therapy on temporal artery biopsy yield in giant cell arteritis. Semin Arthritis Rheum 2007; 37:13.

3. Jakobsson K, Jacobsson L, Mohammad AJ, et al. The effect of clinical features and glucocorticoids on biopsy findings in giant cell arteritis. BMC Musculoskelet Disord 2016; 17:363.

4. Maleszewski JJ, Younge BR, Fritzlen JT, et al. Clinical and pathological evolution of giant cell arteritis: a prospective study of follow-up temporal artery biopsies in 40 treated patients. Mod Pathol 2017; 30:788.