Giant cell arteritis: peripheral neuropathy is common.

Clinical bottom line (level 4)

  1. A sixth of patients referred with giant cell arteritis for temporal artery biopsy have evidence of peripheral neuropathy.
Casselli et al: Neurology 1988; 38: 352-259
Expires February 2004

The study

Case series with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, USA

166 patients (aged range 55 to 92 years; median 73, 76% female) undergone temporal artery biopsy for suspected giant cell arteritis
Oral steroids (typically prednisone 40-60 mg od) for 13 to 20 months; median 17).

100% followed for Mean of 17 months
Outcomes studied:
  • neuropathy
  • stroke or transient ischaemic attack
  • ophthalmic complication
  • amaurosis fugax
  • permanent vision loss
  • large artery disease
  • carotid arteries
  • upper limb weakness
  • lower limb weakness

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    neuropathy Mean of 17 months 23/166 13.9%
    (8.60% to 19.1%)
    stroke or transient ischaemic attack Mean of 17 months 12/166 7.23%
    (3.29% to 11.2%)
    ophthalmic complication Mean of 17 months 35/166 21.1%
    (14.9% to 27.3%)
    amaurosis fugax Mean of 17 months 17/166 10.2%
    (5.63% to 14.9%)
    permanent vision loss Mean of 17 months 14/166 8.43%
    (4.21% to 12.7%)
    large artery disease Mean of 17 months 52/166 31.3%
    (24.3% to 38.4%)
    carotid arteries Mean of 17 months 32/166 19.3%
    (13.3% to 25.3%)
    upper limb weakness Mean of 17 months 30/166 18.1%
    (12.2% to 23.9%)
    lower limb weakness Mean of 17 months 15/166 9.04%
    (4.68% to 13.4%)

    Citation

    1. Casselli RJ, Hunder GG, Whisnant JP: Neurologic disease in biopsy-proven giant cell (temporal) arteritis. Neurology 1988; 38: 352-259
    Search Terms: reference in Buchbinder and Detsky: J Rheum 1992: 19: 1220-8
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient patients
    Intervention or Exposure giant cell arteritis
    Outcome prevalence of complications