The Relationship between the Clinical Assessment, Temporal Artery Biopsy and the Positive Diagnosis of Giant Cell Arteritis

Natalie Duffy, BAppSc(Orth) MTeach
Gordon Eye Surgery, Gordon, Australia

Purpose: The purpose of this study was to examine the relationship between the clinical assessment, histology report and the positive diagnosis of giant cell arteritis.

Methods: In 2011, a retrospective study (2005-2011) of 40 diagnosed temporal artery biopsy patients was conducted at an ophthalmic practice in Sydney, NSW. All patients had been consulted by the same neuro-ophthalmologist prior to the biopsy. Relevant data was extracted from patients’ records and entered into a database for statistical analysis. A scoring system was developed for each sign and symptom to facilitate analysis. Patients with incomplete or inaccurate records were excluded from the study.

Results: A total of 40 patients were included in the study. The average age of participants was 78 years (range 55 to 92). At initial presentation, common signs included headache (87%), jaw claudication (45%) and a change in vision (50%). Blood testing revealed raised inflammatory markers of erythrocyte sedimentation rate (ESR) (55%) and C-reactive protein (CRP) (90%) at presentation. A positive final diagnosis of temporal arteritis was made in 72.5% of all patients, despite only 52.5% of cases returning a positive temporal artery biopsy result.

Conclusion: This study has supported the importance of a temporal artery biopsy in combination with a detailed clinical assessment in the diagnosis of giant cell arteritis. In an ophthalmic setting a temporal artery biopsy is a useful tool to assist diagnosis, however with a false-negative risk careful clinical evaluation by the orthoptist and neuro-ophthalmologist will ensure that giant cell arteritis is promptly detected in patients.