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QJM Advance Access published online on November 15, 2005
QJM, doi:10.1093/qjmed/hci141
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© The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: Journals.permissions@oxfordjournals.org
Received August 17, 2005
Revised October 2, 2005

Original paper

Does temporal artery biopsy influence the management of temporal arteritis?

J. Lenton 1, R. Donnelly 1 *, and J.R. Nash 1

1 From the Department of Vascular Surgery, Derby Hospitals NHS Foundation Trust, Derby, and School of Medical & Surgical Sciences, University of Nottingham, Nottingham, UK

* To whom correspondence should be addressed.
R. Donnelly, E-mail: richard.donnelly{at}nottingham.ac.uk


  Abstract

Background: Temporal arteritis (TA) is the commonest form of primary vasculitis. Symptoms are variable, and therefore the diagnosis (or exclusion) of TA is often difficult. Surgeons are frequently asked to perform a temporal artery biopsy (TAB), but whether the histological result actually influences clinical management is unclear.

Aim: To assess whether, in routine clinical practice, a TAB affects clinical decision-making in patients with suspected TA.

Design: Retrospective audit.

Methods: All patients who underwent a TAB in a single hospital over a 2-year period were identified. This included patients referred from different specialist departments. Individual patient records were examined to document the TAB result, and in particular, the timings of commencement and discontinuation of corticosteroid therapy.

Results: A total of 44 patients were included. TAB was positive in seven patients and negative in 37. In 31, there was no change in their clinical management despite a negative biopsy result: 18 continued with corticosteroids for >6 months with a clinical diagnosis of TA, and in 13 patients a decision to stop steroids, or an alternative diagnosis, was made before the biopsy result was known.

Discussion: In this retrospective study, only a small number of TABs provided positive histological confirmation of TA, and in most patients undergoing TAB, there was little evidence that clinical decision-making with respect to corticosteroid therapy was influenced by the TAB result.


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