Giant cell arteritis: a normal ESR could not rule it out.

Clinical bottom line (level 4)

  1. A quarter of patients with giant cell arteritis had a normal ESR when first seen.
  2. The ESR did not usefully predict subsequent complications or worsening symptoms.
Ellis and Ralston: Annals of the Rheumatic Diseases 1983; 42: 168-170
Expires February 2004

The study

Setting: university hospital, UK

80 patients (aged mean 72 years, 69% female) suspected giant cell arteritis or polymyalgia rheumatica. Criteria: aged >55; positive response to steroids within 48 hours; positive temporal artery biopsy; proximal and symmetrical girdle or upper arm muscle pain with or without stiffness and weakness; jaw claudication; clinically abnormal temporal artery; systemic signs or symptoms; temporal headache; visual disturbance (loss, diplopia, blurring). Patients were included if they had criteria 1-3 plus any three from 5-10 or criteria 4.

Excluded if
  • myeloma
  • rheumatoid arthritis
  • systemic lupus erythromatosis
  • polymyositis
  • disseminated malignancy



    • Independent blinded reference standard, applied in all patients from a consecutive inappropriate spectrum.
    Reference standard:
    • temporal artery biopsy
    Diagnostic test: erythrocyte sedimentation rate (ESR)

    The evidence


    differential diagnosis number of patients prevalence
    (95% CI)
    ESR < 30 mm/ hr on admission 18 22.5%
    (13.1% to 31.7%)

    • On follow-up, increase in ESR was not significantly associated with vision loss or deterioration in symptoms.

    Citation

    1. Ellis ME, and Ralston S: The ESR in the diagnosis and management of polymyalgia rheumatica/giant cell arteritis syndrome. Annals of the Rheumatic Diseases 1983; 42: 168-170
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient suspected giant cell arteritis
    Intervention or Exposure ESR
    Comparison tempora artery biopsy
    Outcome diagnosis