Giant cell arteritis: was commoner with jaw claudication, abnormal temporal arteries or diplopia.

Clinical bottom line (level 4)

  1. 40% of patients with suspected giant cell arteritis had it.
  2. Temporal artery biopsy could not effectively rule out temporal arteritis, but a positive result was diagnostic.
  3. Temporal arteritis was more likely in patients with jaw claudication (LR+12.4) , or a clinically abnormal temporal artery (LR+1.70) .
  4. Temporal arteritis was less likely in patients with tongue claudication (LR+0.11) .
Hall et al: Lancet (Nov 26) 1983; : 1217-1220
Expires February 2004

The study

Setting: teaching hospital, USA

134 patients (aged range 47 to 92; mean 72, 65% female) undergone temporal artery biopsy

Excluded if
  • < or = 16 years



    • ?independent blinded reference standard, applied in all patients from a consecutive ?appropriate spectrum.
    Reference standard:
    • temporal artery biopsy
    Diagnostic test: record review of clinical findings

    The evidence


    differential diagnosis number of patients prevalence
    (95% CI)
    polymyalgia rheumatica 47 35.1%
    (27.0% to 43.2%)
    non-specific headache 21 15.7%
    (9.50% to 21.8%)
    infection 12 9.00%
    (4.10% to 13.8%)
    cardiac emboli or arthrosclerosis 12 9.00%
    (4.10% to 13.8%)
    connective tissue disease 12 9.00%
    (4.10% to 13.8%)
    other 13 9.70%
    (4.70% to 14.7%)


    diagnostic test giant cell arteritis no giant cell arteritis LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    temporal artery biopsy 46 8 -
    (23.0 to -)     		100% 0.15
    (0.08 to 0.28)     		9.00%
    total 54 80


    diagnostic test giant cell arteritis no giant cell arteritis LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    polymyalgia rheumatica 17 37 0.72
    (0.45 to 1.15)     		33.0% 1.22
    (0.93 to 1.59)     		45.0%
    other myalgia/arthralgia 3 51 1.11
    (0.26 to 4.77)     		43.0% 0.99
    (0.92 to 1.08)     		40.0%
    malaise/weight loss 13 41 0.88
    (0.48 to 1.58)     		37.0% 1.05
    (0.86 to 1.28)     		41.0%
    fever 15 39 0.85
    (0.50 to 1.07)     		37.0% 1.07
    (0.85 to 1.34)     		42.0%
    jaw pain/claudication 25 29 12.4
    (3.92 to 38.9)     		89.0% 0.56
    (0.43 to 0.72)     		27.0%
    recent onset headache 32 22 0.95
    (0.72 to 1.25)     		39.0% 1.09
    (0.71 to 1.67)     		42.0%
    visual loss 11 43 0.78
    (0.41 to 1.48)     		34.0% 1.08
    (0.89 to 1.30)     		42.0%
    diplopia 5 49 0.63
    (0.22 to 1.74)     		33.0% 1.05
    (0.94 to 1.18)     		46.0%
    tongue claudication 2 52 0.11
    (0.03 to 0.44)     		7.00% 1.45
    (1.23 to 1.71)     		50.0%
    clinically abnormal temporal artery 31 23 1.70
    (1.16 to 2.50)     		53.0% 0.64
    (0.45 to 0.91)     		30.0%
    scalp tenderness 4 51 0.73
    (0.23 to 2.30)     		33.0% 1.03
    (0.93 to 1.14)     		41.0%
    facial swelling 5 49 1.85
    (0.52 to 6.59)     		56.0% 0.96
    (0.87 to 1.05)     		39.0%
    total 54 80

    Comments

    1. More patients with negative results had bilateral biopsies.

    Citation

    1. Hall S, Persellin S, Lie JT, et al: Therapeutic impact of temporal artery biopsy. Lancet (Nov 26) 1983; : 1217-1220
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient had a temporal artery biopsy
    Intervention or Exposure clinical findings
    Comparison temporal artery biopsy
    Outcome diagnosis