Giant cell arteritis: was more likely with jaw claudication, anorexia or anaemia.

Clinical bottom line (level 4)

  1. A third of patients undergoing temporal artery biopsy for suspected giant cell arteritis had it.
  2. Giant cell arteritis was more likely in patients with jaw claudication (LR+) , anorexia (LR+) or anaemia (LR+2.0) .
Fernandez-Herlhy : Journal of Rheumatology 1988; 15: 1797-1801
Expires February 2004

The study

Setting: university hospital, USA

107 patients (aged ?, ?% male) who had undergone a temporal artery biopsy for giant cell arteritis

Excluded if
  • insufficient information



    • Non-independent ?blinded reference standard, applied in all patients from a consecutive ?appropriate spectrum.
    Reference standard:
    • Single temporal artery biopsy. Positive if a positive biopsy or scarring consistent with healed temporal arteritis. If negative, some patients had a contralateral biopsy.
    Diagnostic test: signs and symptoms noted in medical records

    The evidence

    pre-test probability of giant cell arteritis: 22%, (95% CI: 19% to 26%)

    diagnostic test giant cell arteritis no giant cell arteritis LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    jaw claudication 15 1 26
    (3.6 to 190)     		94% 0.62
    (0.49 to 0.80)     		26%
    anorexia 11 5 3.8
    (1.4 to 10)     		69% 0.77
    (0.63 to 0.95)     		31%
    anaemia 23 20 2.0
    (1.3 to 3.2)     		53% 0.58
    (0.39 to 0.87)     		25%
    psychological symptoms 5 3 2.9
    (0.73 to 12)     		63% 0.91
    (0.80 to 1.04)     		34%
    fever 11 13 1.5
    (0.73 to 3.0)     		46% 0.89
    (0.71 to 1.1)     		34%
    weight loss 9 11 1.4
    (0.65 to 3.1)     		45% 0.92
    (0.75 to 1.1)     		34%
    scalp tenderness 21 29 1.3
    (0.85 to 1.9)     		42% 0.80
    (0.54 to 1.2)     		32%
    polymyalgia rheumatica 14 19 1.3
    (0.73 to 2.3)     		42% 0.89
    (0.67 to 1.2)     		34%
    recent onset headache 22 33 1.2
    (0.80 to 1.7)     		40.0% 0.85
    (0.55 to 1.3)     		33%
    arthralgia 6 14 0.75
    (0.31 to 1.79)     		30% 1.1
    (0.89 to 1.3)     		38%
    visual symptoms 11 29 0.66
    (0.37 to 1.2)     		28% 1.3
    (0.94 to 1.7)     		42%
    total 39 68

    Comments

    1. The study was retrospective.
    2. Polymyalgia rheumatica was defined as pain and stiffness in neck and proximal extremities for >4 weeks with and ESR >50 mm/hr.
    3. Anaemia was defined as haemoglobin <13.5 g/dl or haemocrit <43% in men; haemoglobin <12 g/dl or haemocrit <36% in women.

    Citation

    1. Fernandez-Herlhy L, : Temporal arteritis: clinical aids to diagnose. Journal of Rheumatology 1988; 15: 1797-1801
    Search Terms: arterit* in Cochrane and Best Evidence
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer: Martin Dawes

    Clinical Question.
    Patient suspected giant cell arteritis
    Intervention or Exposure signs and symptoms in medical record
    Comparison temporal artery biopsy
    Outcome diagnosis