Giant cell arteritis: temporal artery biopsies were best performed bilaterally and in painful or inflamed areas.

Clinical bottom line (level 4)

  1. A fifth of patients with suspected giant cell arteritis had it.
  2. Doppler flow studies of temporal arteries were unhelpful in identifying the best biopsy site.
  3. Areas of pain and inflammation could help identify sites where giant cell arteritis may be present. However vessels that appeared normal may still have giant cell arteritis.
  4. Bilateral artery biopsy detected more cases of giant cell arteritis than unilateral biopsy.
Ponge et al: Journal of Rheumatology 1988; 15: 997-1000
Expires February 2001

The study

Setting: university hospital, France

200 patients (aged mean 74 years, 62% female) suspected giant cell arteritis

Non-independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • bilateral temporal artery biopsy (positive if two or more sites of fragmentation of internal limiting membrane, presence of giant cells in infiltrate or presence of granuloma in tunica interna or media). First biopsy site guided by local clinical examination or Doppler abnormalities 'as often as possible'. Second performed on contralateral side at a randomly chosen site. Follow-up if biopsy negative.
Diagnostic test: Clinical examination score: assessed for pain (one point), local inflammation (2), artery red and protruding (1), swelling (1). Positive if score = 2. Doppler flow study: vessel classified as normal, stenosed or clotted.

The evidence

pre-test probability of giant-cell arteritis: 21%, (95% CI: 15% to 26%)

diagnostic test giant cell arteritis no giant cell arteritis LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
clinical exam-guided biopsy 24 18 6.02
(3.48 to 10.4) 		62.0% 0.47
(0.33 to 0.67) 		11.0%
Doppler-guided biopsy 39 3 1.09
(0.98 to 1.21) 		22.0% 0.49
(0.15 to 1.56) 		12.0%
total 42 158

Citation

  1. Ponge T, Barrier JH, Grolleau J-Y, et al: The efficacy of selective unilateral temporal artery biopsy versus bilateral biopsies for diagnosing giant cell arteritis. Journal of Rheumatology 1988; 15: 997-1000
Contributor: Chris Ball and Clare Wotton, February 2000
Reviewer:

Clinical Question.
Patient suspected giant cell arteritis
Intervention or Exposure clinical examination score and Doppler flow study
Comparison temporal artery biopsy
Outcome diagnosis