Giant cell arteritis: ESR or plasma viscosity helped to diagnose.

Clinical bottom line (level 4)

  1. In patients with suspected giant cell arteritis, raised ESR (>60) made it more likely (LR+6.93) , and no raised ESR made it slightly less likely (LR-0.15) .
  2. Raised plasma viscosity (>1.9) made giant cell arteritis slightly more likely (LR+3.47) , and no raised plasma viscosity made it slightly less likely (LR-0.18) .
Brittain et al: British Journal of Ophthalmology 1991; 75: 656-659
Expires February 2004

The study

Setting: eye clinic, UK

31 patients (aged ?, ?% male) suspected giant cell arteritis randomly assigned to the study

Excluded if
  • no temporal artery biopsy



    • Non-independent ?blinded reference standard, applied in all patients from a non-consecutive appropriate spectrum.
    Reference standard:
    • temporal artery biopsy
    Diagnostic test: erythrocyte sedimentation rate and plasma viscosity

    The evidence


    diagnostic test giant cell arteritis no giant cell arteritis LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    ESR > 60mm/hr 15 16 6.93
    (1.87 to 25.7)     		87.0% 0.15
    (0.04 to 0.56)     		13.0%
    plasma viscosity- positive > 1.9 units 17 14 3.47
    (1.45 to 8.29)     		76.0% 0.18
    (0.05 to 0.67)     		14.0%
    total 15 16

    Comments

    1. Serious flaws in this study; not independent, ESR and plasma viscosity only measured if there was a strong intention to biopsy. Will tend to make tests appear better than they really are.
    2. Normal values for ESR <20 in men, <25 in women.
    3. Normal values for plasma viscosity, 1.5 to 1.72.
    4. 14/15 (93%) of patients had some degree of visual loss- of these, 11 (79%) had no recovery.

    Citation

    1. Brittain GH, McIlwaine GG, Bell JA, et al: Plasma viscosity or erythrocyte sedimentation rate in the diagnosis of giant cell arteritis?. British Journal of Ophthalmology 1991; 75: 656-659
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient suspected giant cell arteritis
    Intervention or Exposure ESR and plasma viscosity
    Comparison temporal artery biopsy
    Outcome diagnosis