Giant cell arteritis: some clinical signs helped diagnosis.

Clinical bottom line (level 4)

  1. Half of patients with suspected giant cell arteritis had it.
  2. In patients with suspected giant cell arteritis, those with a positive temporal artery biopsy had it (reference standard) (LR+-) , and those with a negative one were slightly less likely to have it (LR-0.19) .
  3. Patients with jaw claudication were slightly more likely to have it (LR+3.50) , and those without were slightly less likely to (LR-0.66) .
  4. Patients with any of recent onset headache, jaw claudication or abnormal temporal artery were slightly more likely to have it (LR+2.90) , and those without did have it (LR-0.00) .
  5. Patients with clinically abnormal temporal artery were slightly more likely to have it (LR+2.33) and those without were slightly less likely to (LR-0.24) .
Vilaseca et al: Annals of the Rheumatic Diseases 1987; 46: 282-285
Expires February 2004

The study

Setting: two hospitals, Spain

103 patients (aged range 34 to 87 years; median 70, 62% female) undergoing temporal artery biopsy

Independent blinded reference standard, applied in all patients from a consecutive inappropriate spectrum.
Reference standard:
  • temporal artery biopsy. Final diagnosis of temporal arteritis assumed if the patients was: >55 years; had a positive response to steroids within 48 hours; history lasting >2 weeks and at least three of: positive biopsy; proximal and symmetrical girdle upper arm muscles painful/stiff/tender; jaw claudication; clinically abnormal temporal artery (tender, thickened, red); systemic symptoms or signs (malaise, anorexia, weight loss, anaemia, pyrexia); recent onset headache; visual disturbance (loos, dip, blurring)
Diagnostic test: record review of clinical findings

The evidence


diagnostic test giant cell arteritis no arteritis LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
temporal artery biopsy 45 0 -
(14 to -) 		100% 0.19
(0.11 to 0.34) 		17.0%
any of recent onset headache, jaw claudication, abnormal temporal artery 45 0 2.90
(2.03 to 4.13) 		69.0% 0.00
(0.00 to 0.10) 		0.00%
jaw claudication 19 26 3.50
(1.61 to 7.59) 		73.0% 0.66
(0.50 to 0.86) 		34.0%
clinically abnormal temporal artery 38 7 2.33
(1.62 to 3.36) 		64.0% 0.24
(0.12 to 0.49) 		16.0%
total 45 58

Comments

  1. This is retrospective and the subjects have been highly selected (53% suspected had GCA) in contrast to an alternative report of 20% of suspected but unselected patients (Ponge 1988).
  2. Negative biopsies were longer than positive (1.4 mm; 95% CI: 0.2 to 6.0%); p<0.005.

Citation

  1. Vilaseca J, Gonzalez A, Cid MC, et al: Clinical usefulness of temporal artery biopsy. Annals of the Rheumatic Diseases 1987; 46: 282-285
Contributor: Chris Ball and Clare Wotton, February 2000
Reviewer: Marianne Empson

Clinical Question.
Patient suspected giant cell arteritis
Intervention or Exposure clinical signs
Comparison temporal artery biopsy
Outcome diagnosis