Materiały źródłowe

• #1 Giant cell arteritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/diagnosis-treatment/drc-20372764

  Giant cell arteritis can be difficult to diagnose because its early symptoms resemble those of other common conditions. For this reason, your doctor will try to rule out other possible causes of your problem. […] In addition to asking about your symptoms and medical history, your doctor is likely to perform a thorough physical exam, paying particular attention to your temporal arteries. Often, one or both of these arteries are tender, with a reduced pulse and a hard, cordlike feel and appearance. […] Your doctor might also recommend certain tests. […] The following tests might be used to help diagnose your condition and to follow your progress during treatment. […] The best way to confirm a diagnosis of giant cell arteritis is by taking a small sample (biopsy) of the temporal artery.

• #1 Diagnosis and Treatment of Temporal Arteritis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0415/p2490.html

  Elderly patients are more likely to be affected by temporal arteritis (TA), an inflammatory vasculitis. Patients with TA tend to present in a variety of ways, with ocular and systemic symptoms. Lee and Brazis developed a guide for the evaluation of patients with TA based on a search of the literature from 1966 to 1998. The authors developed the following criteria for evaluation of patients: (1) clinical suspicion, (2) laboratory testing and (3) temporal artery biopsy. […] Clinical suspicion can be based, in part, on the American College of Rheumatology study that determined highly sensitive parameters for diagnosis of TA. These parameters include age more than 50 years, a Westergren erythrocyte sedimentation rate (ESR) of more than 50 mm per hour and an abnormal temporal artery biopsy. […] High clinical suspicion includes any one of these three criteria in a patient more than 50 years of age with an elevated ESR, or if three or more of the following four criteria are met: (1) new localized headache, (2) temporal artery abnormality, (3) elevated ESR (more than 50 mm per hour) and (4) abnormal temporal artery biopsy (e.g., necrotizing arteritis or multinucleated giant cells).

• #1 Temporal arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765614/

  Temporal arteritis, also termed giant cell arteritis (GCA), is an immune-mediated vasculitis that affects medium and large vessels. […] The gold standard for diagnosis is tissue confirmation from a temporal artery biopsy. […] The American College of Rheumatology criteria for the diagnosis of temporal arteritis include the following: Age at onset greater than 50 years, Onset of a new headache, Elevated ESR of greater than 50 mm/h, Temporal artery abnormality such as tenderness or reduced pulsation, An abnormal arterial biopsy confirming the presence of temporal arteritis. […] Using the American College of Rheumatology criteria, the presence of 3 or more of the 5 is sufficient to make a diagnosis of temporal arteritis with a sensitivity of 93.5% and specificity of 91.2%. […] Therefore the diagnosis of temporal arteritis is still based on clinical suspicion and a biopsy is mandatory unless there are contraindications.

• #1 Giant Cell Arteritis (Temporal Arteritis): Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/temporal-arteritis-giant-cell-arteritis

  Giant cell arteritis (GCA), previously known as temporal arteritis, is a form of vasculitis (inflammation of your blood vessels). It affects the large blood vessels in your body, particularly the arteries in your head, neck and arms. These arteries become inflamed, swollen and constricted (narrowed). Inflammation and narrowing of these arteries can interrupt their blood flow, which can damage vital organs and tissues. […] Your healthcare provider will ask about your medical history and perform a physical examination. Theyll check to see if your pulses are weak in your arms and legs. Theyll also examine your head to look for scalp tenderness or swelling of your temporal arteries. […] Your healthcare provider will first order blood tests, like erythrocyte sedimentation rate and C-reactive protein, to measure how much inflammation you have in your body. They may also test for anemia by measuring your hemoglobin levels (the part of your red blood cells that carries oxygen).

• #1 Giant Cell Arteritis (Temporal Arteritis) Workup: Approach Considerations, Temporal Artery Biopsy, Ultrasonography

  https://emedicine.medscape.com/article/332483-workup

  Superficial temporal artery biopsy (TAB) is the criterion standard for diagnosing temporal arteritis. TAB should be obtained almost without exception in patients in whom GCA is suspected clinically. It is important because the treatment course for GCA is long and often complicated, and many of the nonspecific symptoms of GCA (eg, headache, body aches, fatigue) occur in myriad other disorders. A positive TAB has 100% specificity but relatively low sensitivity (15%-87%) for the diagnosis of GCA. […] Statistical prediction models can guide decisions to perform temporal artery biopsy and initiate glucocorticoids in giant cell arteritis (GCA), but do not supplant clinical judgment. […] The laboratory hallmarks of GCA include elevation in the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level and thrombocytosis. The ESR usually exceeds 50 mm/h and may exceed 100 mm/h, but may be normal in 7-20% of patients with GCA. Therefore, a normal ESR does not rule out GCA, and the level of elevation of ESR does not correlate reliably with the severity of the disease.

• #1 Giant Cell Arteritis (Temporal Arteritis) Workup: Approach Considerations, Temporal Artery Biopsy, Ultrasonography

  https://emedicine.medscape.com/article/332483-workup

  CRP is of hepatic origin. The level usually rises before ESR in most disease states, and is often elevated in GCA. It has higher sensitivity and specificity than ESR (98.6% and 75.7%, respectively) and is relatively unaffected by age, gender, and other hematologic parameters. […] Nonconcordance between ESR and CRP can occur (ie, either an elevated ESR with normal CRP or a normal ESR with an elevated CRP). The use of both tests provides a slightly greater sensitivity for the diagnosis of GCA (99%) than the use of either test alone. […] A complete blood cell count (CBC) should always be obtained. […] Platelet counts are mildly elevated in most patients. A platelet count greater than 400,000/L, although not in itself diagnostic, is more helpful than an elevated ESR for ruling in GCA. Conversely, a normal platelet count is more accurate than a normal ESR for ruling out GCA.

• #1 Temporal arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765614/

  Temporal artery biopsy is the gold standard test and should be considered in any individual over age 50 years with new onset headache, systemic symptoms such as fever, malaise, and weight loss, and jaw claudication, where there is a considerable suspicion of temporal arteritis. […] The sensitivity of a temporal artery biopsy ranges from 70% to 90%, thus a negative biopsy does not exclude the diagnosis. […] In such cases where there is a high clinical suspicion, bilateral temporal artery biopsies should be performed. […] Typical features of temporal arteritis include an inflammatory infiltrate affecting the adventitia and media and fragmentation of the elastic lamina. […] Increased levels of acute phase reactants such as the ESR, CRP, and interleukin-6 may occur in the presence of temporal arteritis.

• #1 Giant Cell Arteritis (Temporal Arteritis) Workup: Approach Considerations, Temporal Artery Biopsy, Ultrasonography

  https://emedicine.medscape.com/article/332483-workup

  Superficial temporal artery biopsy (TAB) is the criterion standard for making a diagnosis of temporal arteritis. A positive TAB is diagnostic of GCA (100% specificity). The reported sensitivity of TAB has ranged widely, from as low as 15% to as high as 87%. […] TAB should be performed as soon as possible after clinical suspicion is raised. If the index of suspicion is high, the clinician should not delay starting therapy while awaiting TAB. […] Studies have found that bilateral biopsies do not increase the diagnostic yield in the vast majority of patients (99%). […] The clinical significance of giant cells seen on TAB in temporal arteritis is unknown. […] The presence of a headache and jaw claudication may also increase the yield. […] Although superficial temporal artery biopsy remains the standard for diagnosis of giant cell arteritis (GCA), color duplex ultrasonography can be used to diagnose GCA. A hypoechoic halo around the temporal artery lumen on color duplex sonograms has demonstrated high specificity for GCA, but limited sensitivity.

• #1 Giant Cell Arteritis – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/giant-cell-arteritis/

  Giant cell arteritis is best described as an inflammatory vascular condition characterized by cranial and/or large vessel vasculitis, systemic inflammation, and polymyalgia rheumatica, all of which commonly overlap. […] Diagnosing giant cell arteritis can be challenging. Duplex ultrasonography is a valuable diagnostic tool that can be used in clinics. The gold standard test for the diagnosis of GCA is temporal artery biopsy (TAB) depicting definitive pathologic diagnosis. […] Since 1990, the most common method for detecting giant cell arteritis has been to meet 3 or more of 5 criteria developed by the ACR: […] The diagnostic gold standard for GCA, TAB must be obtained from the most symptomatic site. […] The specificity of TAB for giant cell arteritis diagnosis is up to 100%, but sensitivity can be as low as 39%.

• #1 Giant cell arteritis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/giant-cell-arteritis?lang=us

  Giant cell arteritis (GCA) is a common granulomatous vasculitis affecting medium to large-sized arteries. It classically presents with involvement of the superficial temporal artery branches, with headache and blindness. Although temporal artery biopsy (TAB) is the gold standard in diagnosing giant cell arteritis, imaging is increasingly playing a role in non-invasive evaluation. […] Importantly, other large vessels, such as the aorta and upper limb arteries, may also be involved, sometimes without cranial involvement. Thus, the term giant cell arteritis is preferred. […] Areas of normal superficial temporal artery interspersed within inflamed sections of artery, known as skip lesions, result in false negatives in up to 8-28% of cases. […] MRI brain with MR vessel wall imaging has a very high negative predictive value in evaluating giant cell arteritis, indeed it has been suggested in one study to obviate the need for temporal artery biopsy if the MRI is normal. […] On MR vessel wall imaging, giant cell arteritis is characterized by mural inflammation in the superficial temporal arteries, best seen on T1 C+ (Gd) sequences, whereby there is mural enhancement and thickening.

• #1 Giant cell arteritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/diagnosis-treatment/drc-20372764

  If you have giant cell arteritis, the artery will often show inflammation that includes abnormally large cells, called giant cells, which give the disease its name. It’s possible to have giant cell arteritis and have a negative biopsy result. […] If the results aren’t clear, your doctor might advise another temporal artery biopsy on the other side of your head.

• #1 Giant Cell Arteritis (Temporal Arteritis) Workup: Approach Considerations, Temporal Artery Biopsy, Ultrasonography

  https://emedicine.medscape.com/article/332483-workup

  Color duplex ultrasonography of the temporal artery has emerged as a promising alternative or complement to TAB. Its specificity is 80%-100% when a dark halo (classic halo sign) is seen about the vessel. This key diagnostic feature is believed to represent vessel wall edema. […] The prospective Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL) study, which included an ultrasound training program for diagnosing GCA, analyzed 381 patients who underwent both ultrasound and TAB within 10 days of starting treatment for suspected GCA, and found that the sensitivity of TAB was 39%, which was significantly lower than previously reported and inferior to that of ultrasound (54%). However, TAB had 100% specificity, versus 81% for ultrasound. […] The TABUL authors noted that performing ultrasound scans in all patients with suspected GCA and performing biopsies only on negative cases would increase the sensitivity of ultrasound to 65% while maintaining specificity at 81%, reducing the need for biopsies by 43%.

• #1 Giant Cell Arteritis

  https://practicalneurology.com/articles/2020-may/giant-cell-arteritis

  Angiography with MRI and contrast can be used as well. Expected changes with GCA include mural edema. Similar to CDUS, the sensitivity decreases with corticosteroid treatment. A meta-analysis showed approximately 73% sensitivity and 88% specificity for GCA. Other imaging modalities, include fluorodeoxyglucose positron emission tomography(FDG-PET)/CT, although this also decreases in sensitivity with steroid treatment and the sensitivity and specificity is lower than biopsy.

• #1 Giant Cell Arteritis – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/giant-cell-arteritis/

  Vascular ultrasound of superficial temporal and axillary arteries should be performed according to current guidelines. Sensitivity for a diagnosis was found to be higher for ultrasound than biopsy (54% vs 39%), but specificity was lower for ultrasound (81% vs 100%). […] In cases of giant cell arteritis with noncranial presentation, MRA can be used to check for large vessel vasculitis. […] Large vessels in patients with GCA are examined using CTA not just to identify any concurrent aortitis but also for diagnosis of patients who do not have the usual cranial giant cell arteritis signs and symptoms. […] When TAB is negative or inconclusive, FFA might be used as a supplementary tool to evaluate individuals with vision loss and a history of giant cell arteritis.

• #1 Approach to the diagnosis of giant cell arteritis – UpToDate

  https://www.uptodate.com/contents/image?imageKey=RHEUM/134374

  Approach to the diagnosis of giant cell arteritis […] While a high ESR and/or CRP increases the diagnostic significance of the above symptoms or signs, low or normal values do not exclude the diagnosis of GCA. However, an ESR and CRP should always be included as part of the initial diagnostic workup since they are almost always elevated in GCA. […] A current or prior diagnosis of PMR increases the diagnostic significance of any of these symptoms or signs because of the association between GCA and PMR. […] For skilled operators, CDUS can be an acceptable alternative to the temporal artery biopsy as an initial diagnostic procedure. Scheduling of the temporal artery biopsy or CDUS should not delay initiation of treatment. […] False negatives can occur with a temporal artery biopsy and CDUS.

• #1 Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0871-z

  Giant cell arteritis (GCA), if untreated, can lead to blindness and stroke. The study’s objectives were to (1) determine a new evidence-based benchmark of the extent of diagnostic delay for GCA and (2) examine the role of GCA-specific characteristics on diagnostic delay. Mean diagnostic delay was 9.0 weeks (95% CI, 6.5 to 11.4) between symptom onset and GCA diagnosis. Patients with a cranial presentation of GCA received a diagnosis after 7.7 (95% CI, 2.7 to 12.8) weeks and those with non-cranial GCA after 17.6 (95% CI, 9.7 to 25.5) weeks. The mean delay from symptom onset to GCA diagnosis was 9 weeks, or longer when cranial symptoms were absent. Our research provides an evidence-based benchmark for diagnostic delay of GCA and supports the need for improved public awareness and fast-track diagnostic pathways. Diagnosis of GCA in primary care remains difficult. Delay to diagnosis is therefore not unusual. Delay may also occur as patients may not be aware of the significance of GCA symptoms, such as jaw claudication and temporal artery abnormality, and therefore do not seek healthcare promptly. The mean delay in receiving a diagnosis of GCA ranged from 1.2 (SD 1.6) to 34.7 (34.2) weeks. The pooled mean time between GCA symptom onset and GCA diagnosis was 9.0 weeks (95% CI, 6.5 to 11.4). Our meta-analysis demonstrated that those with cranial GCA received a diagnosis after 7.7 weeks and those with non-cranial GCA after 17.6 weeks. Despite the reported time-period of diagnostic delay being considerably varied within some article samples, on average, patients experience a 9-week delay between the onset of their symptoms and receiving a diagnosis of GCA.

• #1 Preventing Permanent Vision Loss: The Diagnosis and Treatment of Temporal Arteritis | Consultant360

  https://www.consultant360.com/articles/preventing-permanent-vision-loss-diagnosis-and-treatment-temporal-arteritis

  Temporal arteritis is a true ocular emergency that may initially present with systemic manifestations to primary care practitioners. […] If improperly diagnosed, the condition may lead to optic nerve damage, ischemic stroke, myocardial infarction, and permanent vision loss. […] This article reviews common findings and provides a recommended treatment course to prevent any permanent vision loss. […] If left untreated, patients run a significant risk of developing sudden and permanent vision loss, most commonly attributed to arteritic ischemic optic neuropathy (AION). […] However, diagnostic confirmation is not available through noninvasive techniques, which may cause a delay between suspicion and verification of the disease and create a gray area regarding initiation of treatment. […] As soon as temporal arteritis is suspected, steps to confirm the diagnosis and initiate treatment are warranted.

• #1 Giant Cell Arteritis : Johns Hopkins Vasculitis Center

  https://www.hopkinsvasculitis.org/types-vasculitis/giant-cell-arteritis/

  A few patients with GCA do not have positive biopsies. We now know that GCA does not affect every part of every temporal artery but can skip around. When one biopsy is negative, biopsying the temporal artery on the other side can lead to the diagnosis. […] Because blindness from giant cell arteritis is almost irreversible, treatment with 40 to 60 mg of prednisone should be started as soon as the diagnosis is suspected. Although immediate temporal artery biopsy has been preferred, one study suggests that biopsy remains positive within at least the first 2 weeks of corticosteroid therapy. Therapy should not be held pending biopsy. In patients with giant cell arteritis, arterial involvement is patchy: therefore, maximizing the chance of diagnosis requires obtaining a long (3 to 4 cm) segment and examining multiple sections. Positive biopsy specimens show infiltration of the vessel wall with mononuclear inflammatory cells and giant cells, intimal proliferation, and thrombosis. Unilateral biopsy specimens are positive in approximately 85% of patients, and bilateral biopsy specimens are positive in 95%. Patients dramatically improve within 24 to 72 hours of beginning therapy, and the ESR usually normalizes within 1 month. Thereafter, prednisone can be tapered slowly, although most patients require some prednisone for at least 9 months and often longer.

• #1 Giant Cell Arteritis

  https://practicalneurology.com/articles/2020-may/giant-cell-arteritis

  The standard for diagnosis is histopathology of the temporal artery, which is highly specific and sensitive and can be done in an outpatient setting. The biopsy is usually done on a temporal periauricular artery in the scalp to avoid damaging frontal branches that supply the facial nerve. Surgeons will usually take 20 to 25 mm of the artery to get good sensitivity. False-negatives can occur because there may be segmental skip areas within an affected artery. The biopsy usually remains positive for 2 to 6 weeks, in most cases even if steroid treatment has been started. […] Color Doppler ultrasound (CDUS) involves imaging the temporal, facial, occipital, vertebral, axillary, and subclavian arteries to a resolution of 0.1 mm. Affected vessels will show the halo sign, a darkened area around the vascular lumen caused by edema. This can turn into the compression sign, in which the area of the vessel remains visible after compression by the ultrasound probe. The sensitivity of this technique is 28.6% to 100% and may be operator dependent. There is evidence that these changes are not visible after treatment with corticosteroids. It is, therefore, still not widely used.

• #1

  https://www.healio.com/news/rheumatology/20200928/no-single-sign-symptom-adequate-to-rule-in-or-rule-out-giant-cell-arteritis

  Although no single sign or symptom alone is strong enough to confirm a diagnosis of giant cell arteritis, a collection of features, including limb claudication and temporal artery thickening, are most informative, according to findings published in JAMA Internal Medicine. […] Making a diagnosis of giant cell arteritis (GCA) can be challenging, Kornelis S. M. van der Geest, MD, PhD, of the University of Groningen, in the Netherlands, told Healio Rheumatology. […] Since no single clinical or laboratory feature is sufficient to rule in or rule out the disease, additional investigations such as vascular imaging and/or temporal artery biopsy are required, Kornelis S. M. van der Geest told Healio Rheumatology. […] No single clinical or laboratory feature is sufficient to rule in or rule out GCA, van der Geest said.

• #1 Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

  https://www.mdpi.com/2077-0383/10/16/3704

  The most recent EULAR guidelines recommended the use of high-resolution 3-T MRI of cranial arteries as an alternative for GCA diagnosis if US is not available or is inconclusive. […] The 2018 EULAR imaging guidelines for LVV include PET/CT as an imaging modality of choice for LVV-GCA diagnosis, based on the results of several meta-analyses that confirmed its diagnostic accuracy. […] In conclusion, the use of imaging techniques has revolutionized the diagnosis of GCA, making it possible to improve the early diagnosis of GCA. In particular, temporal artery US has become the main imaging technique in the clinical evaluation and treatment of GCA, and it is currently used in most centers treating patients with GCA.

• #1 Giant Cell Arteritis Fast Track Clinic – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/medicine/rheumatology-inflammation-immunity/arthritis-and-joint-diseases-center/fast-track-clinic-for-giant-cell-arteritis

  The Fast Track Clinic for Giant Cell Arteritis at Brigham and Womens Hospital (BWH) offers rapid evaluation for patients with suspected giant cell arteritis. […] Because of the risk of permanent vision loss with giant cell arteritis, prompt diagnosis and treatment of the condition is essential. We provide patients with evaluation by our rheumatology team and vascular ultrasound of the temporal, carotid, axillary, and subclavian arteries. Referrals are reviewed by a rheumatologist within one business day of referral and are triaged for acuity. […] Patients are evaluated in our rheumatology clinic as quickly as possible, generally within 2 business days of the referral if the provided information is concerning for a new diagnosis of giant cell arteritis. The rheumatology evaluation is performed by an attending rheumatologist with expertise in GCA diagnosis and management, often with a rheumatology fellow.

• #2 Temporal arteritis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/temporal-arteritis

  Giant cell arteritis is inflammation and damage to the blood vessels that supply blood to the head, neck, upper body and arms. It is also called temporal arteritis. […] Blood tests alone cannot provide a diagnosis. You will need to have a biopsy of the temporal artery. This is a surgical procedure that can be done as an outpatient. […] You may also have other tests, including: Color Doppler ultrasound of the temporal arteries. This may take the place of a temporal artery biopsy if done by someone experienced with the procedure. […] If the diagnosis of giant cell arteritis is made, in most people a biologic medicine called tocilizumab will be added. This medicine reduces the amount of corticosteroids needed to control the disease.

• #2 Giant Cell Arteritis (Temporal Arteritis): Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/temporal-arteritis-giant-cell-arteritis

  Giant cell arteritis (GCA), previously known as temporal arteritis, is a form of vasculitis (inflammation of your blood vessels). It affects the large blood vessels in your body, particularly the arteries in your head, neck and arms. These arteries become inflamed, swollen and constricted (narrowed). Inflammation and narrowing of these arteries can interrupt their blood flow, which can damage vital organs and tissues. […] Your healthcare provider will ask about your medical history and perform a physical examination. Theyll check to see if your pulses are weak in your arms and legs. Theyll also examine your head to look for scalp tenderness or swelling of your temporal arteries. […] Your healthcare provider will first order blood tests, like erythrocyte sedimentation rate and C-reactive protein, to measure how much inflammation you have in your body. They may also test for anemia by measuring your hemoglobin levels (the part of your red blood cells that carries oxygen).

• #2 Temporal arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765614/

  Temporal arteritis, also termed giant cell arteritis (GCA), is an immune-mediated vasculitis that affects medium and large vessels. […] The gold standard for diagnosis is tissue confirmation from a temporal artery biopsy. […] The American College of Rheumatology criteria for the diagnosis of temporal arteritis include the following: Age at onset greater than 50 years, Onset of a new headache, Elevated ESR of greater than 50 mm/h, Temporal artery abnormality such as tenderness or reduced pulsation, An abnormal arterial biopsy confirming the presence of temporal arteritis. […] Using the American College of Rheumatology criteria, the presence of 3 or more of the 5 is sufficient to make a diagnosis of temporal arteritis with a sensitivity of 93.5% and specificity of 91.2%. […] Therefore the diagnosis of temporal arteritis is still based on clinical suspicion and a biopsy is mandatory unless there are contraindications.

• #2 Giant Cell Arteritis

  https://practicalneurology.com/articles/2020-may/giant-cell-arteritis

  The diagnostic criteria for GCA is based on analysis of 214 cases of GCA compared with a sample of 593 patients with other vasculitis types. The traditional criteria, published in 1990, require 3 of 5 criteria and provide sensitivity and specificity of 93.5% and 91.2%, respectively. Those 5 criteria are age 50 or more, new-onset localized headache, temporal artery tenderness or decreased temporal artery pulse, ESR elevated to 50 mm/hour or more, and a consistent biopsy sample. Alternatively, a classification tree of 6 criteria substitutes jaw claudication and scalp tenderness for elevated ESR and a sensitivity and specificity of 95.3% and 90.7%, respectively. […] A 2017 study assessed the continued validity of the 1990 diagnostic criteria, comparing 1,095 people with primary systemic vasculitis with 415 people who had clinical context-specific comparator conditions and found sensitivity and specificity of the 1990 American College of Radiology (ACR) Criteria for GCA patients of 81.1% and 94.9%, respectively. The authors of the 2017 study suggested the variance is due to greater reliance on diagnostic tools and new modern imaging that have expanded the clinical phenotype.

• #2 Giant Cell Arteritis – EyeWiki

  https://eyewiki.org/Giant_Cell_Arteritis

  The physical examination of a patient in whom GCA is suspected should include careful evaluation of the following elements: […] Temporal artery biopsy is the gold standard; however, a negative biopsy does not confirm a negative diagnosis. […] The biopsy should be obtained as soon as possible after the patients presentation, but should not delay the initiation of treatment with corticosteroids. […] The Southend giant cell arteritis (GCA) probability score (GCAPS) is a pre-test tool that helps assess the likelihood of a patient having GCA. […] The diagnosis of GCA should be considered in any patient over the age of 50 with new headaches, acute visual changes, symptoms of polymyalgia rheumatica, unexplained constitutional symptoms, or jaw claudication.

• #2 Giant Cell Arteritis (Temporal Arteritis) Workup: Approach Considerations, Temporal Artery Biopsy, Ultrasonography

  https://emedicine.medscape.com/article/332483-workup

  Superficial temporal artery biopsy (TAB) is the criterion standard for diagnosing temporal arteritis. TAB should be obtained almost without exception in patients in whom GCA is suspected clinically. It is important because the treatment course for GCA is long and often complicated, and many of the nonspecific symptoms of GCA (eg, headache, body aches, fatigue) occur in myriad other disorders. A positive TAB has 100% specificity but relatively low sensitivity (15%-87%) for the diagnosis of GCA. […] Statistical prediction models can guide decisions to perform temporal artery biopsy and initiate glucocorticoids in giant cell arteritis (GCA), but do not supplant clinical judgment. […] The laboratory hallmarks of GCA include elevation in the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level and thrombocytosis. The ESR usually exceeds 50 mm/h and may exceed 100 mm/h, but may be normal in 7-20% of patients with GCA. Therefore, a normal ESR does not rule out GCA, and the level of elevation of ESR does not correlate reliably with the severity of the disease.

• #2 Giant Cell Arteritis : Johns Hopkins Vasculitis Center

  https://www.hopkinsvasculitis.org/types-vasculitis/giant-cell-arteritis/

  How is Giant Cell Arteritis Diagnosed? The diagnosis is made by doing a biopsy of the temporal artery. Using a local numbing medication (the same one used by a dentist), the doctor can remove a small part of the temporal artery from under the scalp and look at it under the microscope for evidence of inflammation. A temporal artery biopsy is almost always safe, causes very little pain, and often leaves little or no scar. […] There are blood tests that help the doctor decide who is likely to have GCA. Almost everyone with the condition has an elevated erythrocyte sedimentation rate (also called sed rate). The sed rate measures how fast a patients red blood cells settle when placed in a small tube. In inflammatory conditions, red blood cells settle more quickly than in noninflammatory states. In addition, most patients with GCA have a slight anemia, or low red blood cell count. Other conditions can also cause a high sed rate or anemia, so the final diagnosis depends on a temporal artery biopsy.

• #2 Understanding Temporal Arteritis: Symptoms, Causes & Treatments

  https://conloneyeinstitute.com/understanding-temporal-arteritis-symptoms-causes-treatments/

  Diagnosing GCA involves clinical evaluation, laboratory tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), imaging studies like ultrasound and MRI, and the gold standard for diagnosis, temporal artery biopsy. […] CRP has been reported to have 100% sensitivity and 97% specificity for GCA diagnosis. […] The 1990 American College of Rheumatology classification criteria for GCA have a sensitivity of 93.5% and a specificity of 91.2%. […] Temporal artery biopsy, however, remains the gold standard for GCA diagnosis. A positive temporal artery biopsy confirms the diagnosis, but physicians must consider all relevant clinical information before deciding whether or not a repeat biopsy is needed. […] Accurate analysis requires a biopsy sample within the artery’s 1 cm to 2.5 cm range. Correct sample size can easily avoid false negatives.

• #2 Giant Cell Arteritis

  https://mobile.fpnotebook.com/Neuro/Eye/GntClArtrts.htm

  Temporal Arteritis (Giant Cell Arteritis) is a systemic large vessel Vasculitis causing Ischemic Optic Neuropathy. […] Strongly consider GCA in over age 60 years old with sudden onset Vision Loss or Diplopia (including transient). […] Start Corticosteroids immediately when diagnosis suspected. […] Temporal Artery Biopsy shows chronic inflammation, necrotizing arteritis. […] Test Sensitivity: 80-92%. […] Consider biopsy of contralateral side if negative biopsy despite high clinical suspicion. […] American College of Rheumatology criteria (3 of 5 criteria required): Age 50 years or older, Localized Headache of new onset, Tenderness or decreased pulse over the temporal artery, ESR 50 mm/h or higher, Temporal artery biopsy with necrotizing arteritis. […] Test Sensitivity approaches 99% in Temporal Arteritis when both ESR and C-RP are obtained. […] Test Sensitivity: 54 to 88%. […] However, ACR recommends biopsy as preferred diagnostic tool. […] Positive Ultrasound: Treat as Temporal Arteritis. […] Biopsy within 1 week of starting Corticosteroids.

• #2 Temporal arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765614/

  Temporal artery biopsy is the gold standard test and should be considered in any individual over age 50 years with new onset headache, systemic symptoms such as fever, malaise, and weight loss, and jaw claudication, where there is a considerable suspicion of temporal arteritis. […] The sensitivity of a temporal artery biopsy ranges from 70% to 90%, thus a negative biopsy does not exclude the diagnosis. […] In such cases where there is a high clinical suspicion, bilateral temporal artery biopsies should be performed. […] Typical features of temporal arteritis include an inflammatory infiltrate affecting the adventitia and media and fragmentation of the elastic lamina. […] Increased levels of acute phase reactants such as the ESR, CRP, and interleukin-6 may occur in the presence of temporal arteritis.

• #2 Clinical Aspects of the Temporal Arteritis

  https://arquivosdeorl.org.br/additional/acervo_eng.asp?Id=570

  The diagnosis is eminently clinical and laboratorial, with histopathological confirmation, and its treatment is made with long-term corticotherapy. […] The Giant Cells Arteritis diagnosis is mostly clinical. Recently the American College of Rheumatology reviewed the GCA diagnostic criteria. By this format, a patient is deemed to be a carrier of GCA if, at least, three of the five criteria are met. The presence of three or more of these five criteria is associated to a sensitivity of 93.55% and a specificity of 91.2%. […] The temporal artery biopsy must be carried out in all patients for whom there is suspicion of GCA based on the anamnesis and physical exam, even if the ESR had been normal. […] The microscopic exam reveals a panarteritis with perivascular inflammatory infiltrate, intimate hypertrophy, medium necrosis associated with granulomatous tissue formation, presence of giant cells and light thrombosis.

• #2 Giant Cell Arteritis : Johns Hopkins Vasculitis Center

  https://www.hopkinsvasculitis.org/types-vasculitis/giant-cell-arteritis/

  A few patients with GCA do not have positive biopsies. We now know that GCA does not affect every part of every temporal artery but can skip around. When one biopsy is negative, biopsying the temporal artery on the other side can lead to the diagnosis. […] Because blindness from giant cell arteritis is almost irreversible, treatment with 40 to 60 mg of prednisone should be started as soon as the diagnosis is suspected. Although immediate temporal artery biopsy has been preferred, one study suggests that biopsy remains positive within at least the first 2 weeks of corticosteroid therapy. Therapy should not be held pending biopsy. In patients with giant cell arteritis, arterial involvement is patchy: therefore, maximizing the chance of diagnosis requires obtaining a long (3 to 4 cm) segment and examining multiple sections. Positive biopsy specimens show infiltration of the vessel wall with mononuclear inflammatory cells and giant cells, intimal proliferation, and thrombosis. Unilateral biopsy specimens are positive in approximately 85% of patients, and bilateral biopsy specimens are positive in 95%. Patients dramatically improve within 24 to 72 hours of beginning therapy, and the ESR usually normalizes within 1 month. Thereafter, prednisone can be tapered slowly, although most patients require some prednisone for at least 9 months and often longer.

• #2 Giant cell arteritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/diagnosis-treatment/drc-20372764

  If you have giant cell arteritis, the artery will often show inflammation that includes abnormally large cells, called giant cells, which give the disease its name. It’s possible to have giant cell arteritis and have a negative biopsy result. […] If the results aren’t clear, your doctor might advise another temporal artery biopsy on the other side of your head.

• #2 Giant cell arteritis: reviewing the advancing diagnostics and management | Eye

  https://www.nature.com/articles/s41433-023-02433-y

  Another widely known factor limiting the sensitivity of TAB is the presence of skip lesions in GCA. […] Skip lesions are estimated to be present in 82-6% of cases and therefore risk false negative results if biopsies are sampled from spared segments of arteries. […] Over recent years, the availability and refinement of imaging services have improved in healthcare settings, with their rapid incorporation into diagnostic and interventional modalities for a multitude of pathologies. […] The EULAR currently recommend the use of temporal and axillary artery ultrasound (US) to confirm the diagnosis of new GCA cases, given the low invasiveness, rapid result availability, and comprehensive inflamed vessel visualisation of the imaging modality. […] Temporal artery ultrasound has been found to be a cost-effective alternative to TAB in reducing false negatives, with US providing a 485 benefit per patient. […] In situations where US is not available or has limited utility (e.g. thoracic aorta assessment), EULAR recommends the use of cross-sectional imaging such as MRI, CT and PET to aid GCA diagnosis in the first instance.

• #2 Comparison of temporal artery ultrasound versus biopsy in the diagnosis of giant cell arteritis | Eye

  https://www.nature.com/articles/s41433-022-01947-1

  Giant cell arteritis (GCA) is a medical and ophthalmological emergency due to risk of stroke and sudden irreversible loss of vision. Fast and accurate diagnosis is important to prevent complications and long-term high dose glucocorticoids toxicity. Temporal artery biopsy is gold standard for diagnosing GCA. However, temporal artery ultrasound is a fast and non-invasive procedure which may provide a supplement or an alternative to biopsy. This study assesses the diagnostic performance of ultrasound and biopsy in the diagnosis of GCA. […] Compared with the final clinical diagnosis, biopsy had a sensitivity of 69% (5183%) and a specificity of 100% (92100%), and ultrasound a sensitivity of 63% (4579%) and a specificity of 79% (6494%). […] Sensitivity of ultrasound is almost on par with that of biopsy although the overall diagnostic accuracy of ultrasound was slightly lower. We find that ultrasound is a reliable tool for first line diagnosis of GCA.

• #2 Giant Cell Arteritis

  https://practicalneurology.com/articles/2020-may/giant-cell-arteritis

  The standard for diagnosis is histopathology of the temporal artery, which is highly specific and sensitive and can be done in an outpatient setting. The biopsy is usually done on a temporal periauricular artery in the scalp to avoid damaging frontal branches that supply the facial nerve. Surgeons will usually take 20 to 25 mm of the artery to get good sensitivity. False-negatives can occur because there may be segmental skip areas within an affected artery. The biopsy usually remains positive for 2 to 6 weeks, in most cases even if steroid treatment has been started. […] Color Doppler ultrasound (CDUS) involves imaging the temporal, facial, occipital, vertebral, axillary, and subclavian arteries to a resolution of 0.1 mm. Affected vessels will show the halo sign, a darkened area around the vascular lumen caused by edema. This can turn into the compression sign, in which the area of the vessel remains visible after compression by the ultrasound probe. The sensitivity of this technique is 28.6% to 100% and may be operator dependent. There is evidence that these changes are not visible after treatment with corticosteroids. It is, therefore, still not widely used.

• #2 Giant cell arteritis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/giant-cell-arteritis?lang=us

  Giant cell arteritis (GCA) is a common granulomatous vasculitis affecting medium to large-sized arteries. It classically presents with involvement of the superficial temporal artery branches, with headache and blindness. Although temporal artery biopsy (TAB) is the gold standard in diagnosing giant cell arteritis, imaging is increasingly playing a role in non-invasive evaluation. […] Importantly, other large vessels, such as the aorta and upper limb arteries, may also be involved, sometimes without cranial involvement. Thus, the term giant cell arteritis is preferred. […] Areas of normal superficial temporal artery interspersed within inflamed sections of artery, known as skip lesions, result in false negatives in up to 8-28% of cases. […] MRI brain with MR vessel wall imaging has a very high negative predictive value in evaluating giant cell arteritis, indeed it has been suggested in one study to obviate the need for temporal artery biopsy if the MRI is normal. […] On MR vessel wall imaging, giant cell arteritis is characterized by mural inflammation in the superficial temporal arteries, best seen on T1 C+ (Gd) sequences, whereby there is mural enhancement and thickening.

• #2 Approach to the diagnosis of giant cell arteritis – UpToDate

  https://www.uptodate.com/contents/image?imageKey=RHEUM/134374

  We routinely evaluate for large vessel involvement in all patients with newly diagnosed cranial GCA by performing CDUS of the epiaortic vessels (eg, carotid, subclavian, and axillary arteries). MRA or CTA is conditionally suggested by the ACR for evaluating for aortic involvement. […] In some cases, GCA is confined to the large vessels (ie, the aorta and/or its first-order branches) instead of the more common form, which involves the cranial arteries. Imaging modalities include MRA, CTA, and PET. CDUS of the epiaortic vessels (eg, carotid, subclavian, and axillary arteries) can also be used to identify large vessel GCA. Selection of a given modality depends on the availability of local resources. […] High-dose glucocorticoid therapy in individuals with negative temporal artery biopsies and large vessel imaging must be carefully considered and reserved for selected patients with a classic clinical presentation of GCA and no other plausible alternative diagnoses. Clinical improvement following a brief trial of high-dose glucocorticoids is nonspecific and should not be relied upon for establishing the diagnosis of GCA.

• #2

  https://link.springer.com/article/10.1007/s11940-020-00660-2

  Giant cell arteritis (GCA), a medium and large vessel vasculitis occurring in the aged, remains a formidable disease, capable of taking both vision and life, through a multitude of vascular complications. […] While a clinical presentation of headache, jaw claudication, scalp tenderness, fever and other systemic symptoms and serum markers are together highly suggestive of the disease, diagnosis can be challenging in those cases in which classic symptoms are lacking. […] There is increasing evidence supporting the use of Doppler ultrasound, dedicated post-contrast T1-weighted spin echo MRI of the scalp arteries and PET scan, which can together improve our diagnostic accuracy in cases in which temporal artery biopsy is either inconclusive or not feasible. […] GCA is no longer a disease whose diagnosis is based exclusively on temporal artery biopsy and whose complications are prevented solely with the use of corticosteroids. Modern vascular imaging techniques and targeted immunologic therapies are heralding a new era for the disease, in which practitioners will hopefully be able to diagnosis it with greater accuracy and treat it with less ischemic complications and iatrogenic side effects.

• #2 Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0871-z

  Giant cell arteritis (GCA), if untreated, can lead to blindness and stroke. The study’s objectives were to (1) determine a new evidence-based benchmark of the extent of diagnostic delay for GCA and (2) examine the role of GCA-specific characteristics on diagnostic delay. Mean diagnostic delay was 9.0 weeks (95% CI, 6.5 to 11.4) between symptom onset and GCA diagnosis. Patients with a cranial presentation of GCA received a diagnosis after 7.7 (95% CI, 2.7 to 12.8) weeks and those with non-cranial GCA after 17.6 (95% CI, 9.7 to 25.5) weeks. The mean delay from symptom onset to GCA diagnosis was 9 weeks, or longer when cranial symptoms were absent. Our research provides an evidence-based benchmark for diagnostic delay of GCA and supports the need for improved public awareness and fast-track diagnostic pathways. Diagnosis of GCA in primary care remains difficult. Delay to diagnosis is therefore not unusual. Delay may also occur as patients may not be aware of the significance of GCA symptoms, such as jaw claudication and temporal artery abnormality, and therefore do not seek healthcare promptly. The mean delay in receiving a diagnosis of GCA ranged from 1.2 (SD 1.6) to 34.7 (34.2) weeks. The pooled mean time between GCA symptom onset and GCA diagnosis was 9.0 weeks (95% CI, 6.5 to 11.4). Our meta-analysis demonstrated that those with cranial GCA received a diagnosis after 7.7 weeks and those with non-cranial GCA after 17.6 weeks. Despite the reported time-period of diagnostic delay being considerably varied within some article samples, on average, patients experience a 9-week delay between the onset of their symptoms and receiving a diagnosis of GCA.

• #2 Atypical Giant Cell Arteritis Case Illustrates Diagnosis, Management Challenges – The Rheumatologist

  https://www.the-rheumatologist.org/article/atypical-giant-cell-arteritis-case-illustrates-diagnosis-management-challenges/

  The diagnosis is suspected clinically based on characteristic symptoms and laboratory findings, and confirmed histologically by temporal artery biopsy. […] A classical presentation is easy to recognize when a patient older than 50 presents with a new-onset headache along with other characteristic findings, such as jaw claudication, symptoms of polymyalgia rheumatica (PMR) and elevated inflammatory markers. […] In clinical practice, however, GCA often presents diagnostic and management challenges. […] A negative temporal artery biopsy despite the high probability of the disease based on clinical presentation. […] Given her negative biopsy results, GCA was considered unlikely, and the prednisone was tapered off over two weeks.

• #2

  https://www.healio.com/news/rheumatology/20200928/no-single-sign-symptom-adequate-to-rule-in-or-rule-out-giant-cell-arteritis

  Although no single sign or symptom alone is strong enough to confirm a diagnosis of giant cell arteritis, a collection of features, including limb claudication and temporal artery thickening, are most informative, according to findings published in JAMA Internal Medicine. […] Making a diagnosis of giant cell arteritis (GCA) can be challenging, Kornelis S. M. van der Geest, MD, PhD, of the University of Groningen, in the Netherlands, told Healio Rheumatology. […] Since no single clinical or laboratory feature is sufficient to rule in or rule out the disease, additional investigations such as vascular imaging and/or temporal artery biopsy are required, Kornelis S. M. van der Geest told Healio Rheumatology. […] No single clinical or laboratory feature is sufficient to rule in or rule out GCA, van der Geest said.

• #2 Preventing Permanent Vision Loss: The Diagnosis and Treatment of Temporal Arteritis | Consultant360

  https://www.consultant360.com/articles/preventing-permanent-vision-loss-diagnosis-and-treatment-temporal-arteritis

  Blood work must be ordered to test for elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelets. […] The current gold standard for diagnosis of temporal arteritis is a temporal artery biopsy. […] However, there is a lag time between a physician suspecting a patient of having the disease and the results of the biopsy becoming available to use in the decision making process. […] If there is a high amount of suspicion based on clinical presentation, it is generally agreed that steroid treatment should be initiated immediately. […] Temporal artery biopsy is needed to confirm the diagnosis of temporal arteritis and justify beginning a patient on long-term systemic steroids.

• #2 Giant Cell Arteritis Part 1: Diagnosis | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/giant-cell-arteritis-part-1-diagnosis/

  GCA is a rheumatological emergency. Rapid diagnosis and treatment are required to reduce the risk of complications. […] In GCA, it is critical to obtain a temporal artery biopsy (TAB) to help confirm the diagnosis. TAB still remains the gold standard diagnostic test in North America. […] A suspected diagnosis of GCA should be confirmed with a temporal artery biopsy (or imaging) even when clinical suspicion is high. […] The sensitivity of a biopsy ranges from 30-70% depending on the centre and longer biopsy lengths have shown higher sensitivity. […] In patients with clinical symptoms of GCA, normal ESR/CRP does not exclude diagnosis of GCA. […] A suspected diagnosis of GCA should be confirmed with a unilateral TAB of at least 1.5 cm in length. TAB should be ideally obtained within two weeks of GC therapy initiation.

• #2 Giant Cell Arteritis

  https://practicalneurology.com/articles/2020-may/giant-cell-arteritis

  Angiography with MRI and contrast can be used as well. Expected changes with GCA include mural edema. Similar to CDUS, the sensitivity decreases with corticosteroid treatment. A meta-analysis showed approximately 73% sensitivity and 88% specificity for GCA. Other imaging modalities, include fluorodeoxyglucose positron emission tomography(FDG-PET)/CT, although this also decreases in sensitivity with steroid treatment and the sensitivity and specificity is lower than biopsy.

• #2

  https://www.healio.com/news/rheumatology/20200928/no-single-sign-symptom-adequate-to-rule-in-or-rule-out-giant-cell-arteritis

  Our study may help clinicians judge the clinical probability of giant cell arteritis based on evidence from 68 diagnostic cohort studies, he added. Since no single clinical or laboratory feature is sufficient to rule in or rule out the disease, additional investigations such as vascular imaging and/or temporal artery biopsy are required.

• #2 Giant Cell Arteritis Fast Track Clinic – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/medicine/rheumatology-inflammation-immunity/arthritis-and-joint-diseases-center/fast-track-clinic-for-giant-cell-arteritis

  Temporal artery biopsy is recommended on a case-by-case basis depending on the rheumatologic evaluation and is performed by the Vascular Surgery team at Brigham and Women’s Hospital. […] BWH is among the few hospitals in the nation to use noninvasive vascular ultrasound in the diagnosis of giant cell arteritis. […] We provide immediate diagnosis, treatment, and if desired, close follow-up for patients diagnosed with giant cell arteritis. […] A rheumatologist reviews all referrals within one business day. If the provided information is concerning for a new diagnosis of giant cell arteritis, a rheumatologist on our team will evaluate the patient as quickly as possible, usually within 2 business days of referral.

• #3 Giant Cell Arteritis (Temporal Arteritis): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/418371-overview

  GCA should always be considered in the differential diagnosis of a new-onset headache in patients 50 years of age or older with an elevated erythrocyte sedimentation rate. Temporal artery biopsy remains the criterion standard for diagnosis of this granulomatous vasculitis. […] However, increasing evidence supports the use of imaging studies for diagnosis in patients at high clinical risk. […] The prognosis for patients with untreated GCA is extremely poor. These patients may suffer blindness, or death from myocardial infarction, stroke, or dissecting aortic aneurysm. […] The clinical utility of high resolution magnetic resonance imaging in the diagnosis of giant cell arteritis: a critically appraised topic. […] The role of unilateral temporal artery biopsy. […] The use of ultrasound as an aid in the diagnosis of giant cell arteritis: a pilot study comparing histological features with ultrasound findings.

• #3 Giant Cell Arteritis (Temporal Arteritis) – Harvard Health

  https://www.health.harvard.edu/a_to_z/giant-cell-arteritis-temporal-arteritis-a-to-z

  Giant cell arteritis, also called temporal arteritis, is a disease in which the large arteries and their branches, including those that supply the eye, scalp, and face, become inflamed and narrowed. This disease can cause loss of vision, so it is essential that the problem be diagnosed and treated as early as possible. […] Your doctor may suspect you have this disorder if you are an older adult with a new headache. He or she will begin by asking you for a detailed description of your symptoms, past medical problems, and medications. Next, the doctor will examine you, paying particular attention to your temporal arteries, located just in front of the ear, above the jaw, and other blood vessels. […] A biopsy of the temporal artery generally is required to confirm the diagnosis. In this procedure, a small piece of the blood vessel will be removed under local anesthesia and will be examined in a laboratory. New research suggests that other tests, including ultrasound of the temporal arteries, may be useful for the detection of this condition, but a biopsy is still considered the best available test.

• #3 Giant Cell Arteritis (Temporal Arteritis) Workup: Approach Considerations, Temporal Artery Biopsy, Ultrasonography

  https://emedicine.medscape.com/article/332483-workup

  Superficial temporal artery biopsy (TAB) is the criterion standard for making a diagnosis of temporal arteritis. A positive TAB is diagnostic of GCA (100% specificity). The reported sensitivity of TAB has ranged widely, from as low as 15% to as high as 87%. […] TAB should be performed as soon as possible after clinical suspicion is raised. If the index of suspicion is high, the clinician should not delay starting therapy while awaiting TAB. […] Studies have found that bilateral biopsies do not increase the diagnostic yield in the vast majority of patients (99%). […] The clinical significance of giant cells seen on TAB in temporal arteritis is unknown. […] The presence of a headache and jaw claudication may also increase the yield. […] Although superficial temporal artery biopsy remains the standard for diagnosis of giant cell arteritis (GCA), color duplex ultrasonography can be used to diagnose GCA. A hypoechoic halo around the temporal artery lumen on color duplex sonograms has demonstrated high specificity for GCA, but limited sensitivity.

• #3 Temporal arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765614/

  Temporal artery biopsy is the gold standard test and should be considered in any individual over age 50 years with new onset headache, systemic symptoms such as fever, malaise, and weight loss, and jaw claudication, where there is a considerable suspicion of temporal arteritis. […] The sensitivity of a temporal artery biopsy ranges from 70% to 90%, thus a negative biopsy does not exclude the diagnosis. […] In such cases where there is a high clinical suspicion, bilateral temporal artery biopsies should be performed. […] Typical features of temporal arteritis include an inflammatory infiltrate affecting the adventitia and media and fragmentation of the elastic lamina. […] Increased levels of acute phase reactants such as the ESR, CRP, and interleukin-6 may occur in the presence of temporal arteritis.

• #3 Giant Cell Arteritis Part 1: Diagnosis | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/giant-cell-arteritis-part-1-diagnosis/

  GCA is a rheumatological emergency. Rapid diagnosis and treatment are required to reduce the risk of complications. […] In GCA, it is critical to obtain a temporal artery biopsy (TAB) to help confirm the diagnosis. TAB still remains the gold standard diagnostic test in North America. […] A suspected diagnosis of GCA should be confirmed with a temporal artery biopsy (or imaging) even when clinical suspicion is high. […] The sensitivity of a biopsy ranges from 30-70% depending on the centre and longer biopsy lengths have shown higher sensitivity. […] In patients with clinical symptoms of GCA, normal ESR/CRP does not exclude diagnosis of GCA. […] A suspected diagnosis of GCA should be confirmed with a unilateral TAB of at least 1.5 cm in length. TAB should be ideally obtained within two weeks of GC therapy initiation.

• #3

  https://link.springer.com/article/10.1007/s11926-010-0135-9

  Giant cell arteritis (GCA), also called temporal arteritis, is a vasculitis that affects large and middle-sized blood vessels with predisposition to the involvement of cranial arteries derived from the carotid artery in individuals older than 50 years of age. […] A temporal artery biopsy is the gold standard test for the diagnosis of GCA. […] Several imaging modalities, in particular ultrasonography, are useful in the diagnosis of GCA. […] This interesting study shows that bilateral TABs increase the diagnostic sensitivity of the procedure by up to 12.7% compared with unilateral biopsies. […] TAB with postfixation length shorter than 5 mm carries an increased biopsy-negative rate. Therefore, longer TAB length is required for accurate diagnosis. Increasing postfixation TAB length beyond 20 mm may further increase the rate of positive biopsies.

• #3 Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

  https://www.mdpi.com/2077-0383/10/16/3704

  According to the last EULAR recommendations for the use of imaging in LVV, US of temporal arteries is recommended as the first imaging tool in patients with suspected predominantly cranial GCA. The four principal US findings in patients with GCA are thickening of the vessel wall or halo sign, non-compressible arteries or compression sign, stenosis, and occlusions. […] Ultrasound in patients with suspected cranial GCA should always include assessment of the temporal and axillary arteries, as stated in the EULAR imaging in LVV recommendations. […] US has become the cornerstone of the GCA fast-track clinics as an imaging tool that favors the early diagnosis of GCA. In these clinics, physicians can refer patients to specialists who can be contacted immediately. Based on clinical and US findings, GCA can be rapidly confirmed or excluded.

• #3 Comparison of temporal artery ultrasound versus biopsy in the diagnosis of giant cell arteritis | Eye

  https://www.nature.com/articles/s41433-022-01947-1

  In the field of rheumatology, temporal artery ultrasound has become an increasingly important diagnostic tool in GCA and is now recommended by the European League Against Rheumatism (EULAR) as the first-line diagnostic procedure in patients with predominantly cranial symptoms of GCA, if skilled sonographers are available. […] The use of diagnostic tests like temporal artery biopsy and ultrasound to confirm GCA should be standard practice. […] The use of ultrasound has emerged as an accessible, fast, and non-invasive tool for the diagnosis of GCA. […] The performance of ultrasound has been evaluated in several studies. […] The use of ultrasound in assessment of suspected GCA patients is in accordance with newly published EULAR recommendations for managing GCA and enables rapid diagnosis of large vessel vasculitis with low burden to patients. Ultrasound is therefore recommended as the first diagnostic test provided it is readily available and performed with high quality.

• #3 Imaging-Only Diagnosis of Giant Cell Arteritis Is Feasible | MedPage Today

  https://www.medpagetoday.com/rheumatology/generalrheumatology/109982

  Positive findings with color Doppler ultrasound were enough to diagnose giant cell arteritis (GCA) accurately without need for confirmation with temporal artery biopsy (TAB), a prospective study indicated. […] „In summary, our study showed that the use of temporal artery ultrasound may be an efficient way to make the diagnosis of GCA in patients with high clinical suspicion and to reduce imaging costs and the need for biopsy, thereby limiting complications and the need for a surgeon,” Denis and colleagues wrote. […] Ultrasound is already an accepted diagnostic tool in GCA, backed by recent guidelines from major rheumatology organizations as a first imaging approach. […] „Suspicion of GCA should be treated as a medical emergency, given the risk for blindness and the potential adverse effects of corticosteroids,” Denis and colleagues explained. „This is why a rapid and effective diagnostic strategy is needed.” […] TAB doesn’t really fill the bill, the researchers argued, because it requires a surgeon’s involvement followed by pathologic examination.

• #3 Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

  https://www.mdpi.com/2077-0383/10/16/3704

  The most recent EULAR guidelines recommended the use of high-resolution 3-T MRI of cranial arteries as an alternative for GCA diagnosis if US is not available or is inconclusive. […] The 2018 EULAR imaging guidelines for LVV include PET/CT as an imaging modality of choice for LVV-GCA diagnosis, based on the results of several meta-analyses that confirmed its diagnostic accuracy. […] In conclusion, the use of imaging techniques has revolutionized the diagnosis of GCA, making it possible to improve the early diagnosis of GCA. In particular, temporal artery US has become the main imaging technique in the clinical evaluation and treatment of GCA, and it is currently used in most centers treating patients with GCA.

• #3 Giant cell arteritis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/giant-cell-arteritis/

  If there is strong clinical suspicion for GCA, glucocorticoids should be administered immediately, even prior to diagnostic workup if needed, to reduce the risk of permanent vision loss and cerebral ischemia. […] Laboratory studies typically show signs of inflammation (e.g., elevated erythrocyte sedimentation rate and CRP), and temporal artery biopsy and/or imaging (e.g., duplex ultrasound) should be performed to confirm the diagnosis of vasculitis. […] If clinical suspicion for GCA is high, initiate high-dose glucocorticoids before the diagnostic workup to minimize the risk of complications such as vision loss or stroke. […] Elevated inflammatory markers (e.g., ESR, CRP) and/or thrombocytosis increase the likelihood of GCA. […] All patients require imaging studies and/or a temporal artery biopsy to confirm the diagnosis of vasculitis.

• #3 Giant Cell Arteritis: Examining Challenges in Diagnosis and Treatment – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/features/giant-cell-arteritis-examining-challenges-in-diagnosis-and-treatment/

  Improved biomarkers are needed to monitor disease activity effectively in giant cell arteritis. […] Because these nonspecific symptoms of giant cell arteritis are also seen in many other conditions, diagnostic delays of 9 weeks or longer are common. […] Diagnostic delay in patients with giant cell arteritis can lead to devastating consequences, including stroke or permanent blindness, making it imperative that clinicians maintain a high index of clinical suspicion for the disease. […] Dr Unizony noted that there are important unmet needs remaining for patients with giant cell arteritis. First, we need more prednisone-sparing options for patients who do not tolerate tocilizumab or [who have a] flare on tocilizumab, he told Rheumatology Advisor. Second, because of its mechanism of action, tocilizumab makes the traditional inflammatory markers ESR and CRP unreliable for monitoring of disease activity. So, we need better biomarkers in giant cell arteritis.

• #3 Temporal arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765614/

  The mainstay of treatment is corticosteroids, which may be supplemented with other immunosuppressives or steroid-sparing agents. […] It is recommended that high-dose steroids be used. […] Treatment should be begun immediately following the clinical suspicion of the diagnosis and should not be delayed while waiting for the results of a temporal artery biopsy.

• #3 Giant cell arteritis: early diagnosis is key | EB

  https://www.dovepress.com/giant-cell-arteritis-early-diagnosis-is-key-peer-reviewed-fulltext-article-EB

  The duration of treatment with corticosteroids may last months to years and is determined by both resolution of patients symptoms and normalization of inflammatory markers (ESR/CRP). […] In summary, clinicians should consider GCA in the differential diagnosis of elderly patients with acute pain in the distribution of the external carotid artery (eg, headache, scalp tenderness); PMR; or acute/transient visual loss or diplopia. Prompt laboratory evaluation (eg, ESR, CRP, platelet count) followed by empiric high-dose corticosteroid therapy is warranted in patients suspected of having GCA.

• #4 Temporal Artery Ultrasound for Diagnosing Giant Cell Arteritislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na57515/2024/05/21/temporal-artery-ultrasound-diagnosing-giant-cell-arteritis

  This procedure — when performed by an experienced clinician — can suffice for confirming the diagnosis. […] Color Doppler ultrasound of the temporal arteries has emerged as an alternative to biopsy for diagnosing giant cell arteritis (GCA). […] Ultrasound was the initial test (after clinical assessment and laboratory testing). If ultrasound was positive (i.e., “halo sign” in both temporal arteries), no further testing was done. […] If ultrasound was negative, temporal artery biopsy was done. […] If both ultrasound and biopsy were negative, clinicians still could diagnose GCA if vasculitis was identified on large-vessel imaging (by computed tomography or magnetic resonance imaging) or if patients had classic clinical presentations. […] Temporal artery ultrasound can obviate the need for biopsy in some patients with suspected GCA. A bilateral positive “halo sign” is only moderately sensitive, but highly specific, for the diagnosis. […] If not, temporal artery biopsy still will be the default approach to establishing the diagnosis.

• #4 Giant cell arteritis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/giant-cell-arteritis/

  Temporal artery biopsy with histopathology is the only study that can definitively confirm GCA and should be considered in all patients, especially if GCA cannot be ruled out with imaging. […] Duplex ultrasound of the temporal arteries (with/without the axillary arteries): first-line imaging technique in suspected GCA. […] High clinical suspicion for GCA despite inconclusive duplex ultrasound. […] These criteria establish the diagnosis of GCA in patients with medium- or large-vessel vasculitis confirmed with imaging or biopsy.

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