FPIN's Clinical Inquiries

Giant Cell Arteritis: Biopsy After Corticosteroid Initiation

 

Am Fam Physician. 2017 Jan 15;95(2):116-117.

Clinical Question

What is the maximum recommended delay for obtaining a temporal artery biopsy after initiation of corticosteroids in patients with suspected giant cell arteritis?

Evidence-Based Answer

Corticosteroid therapy in patients with suspected giant cell arteritis should not degrade the accuracy of temporal artery biopsy if the biopsy is performed within four weeks of corticosteroid initiation. Temporal artery biopsy can be performed up to four weeks after starting high-dose corticosteroid therapy. (Strength of Recommendation: B, based on one small prospective study and multiple retrospective cohort studies.)

Evidence Summary

A 2002 prospective randomized controlled trial enrolled patients with at least three of the four American College of Rheumatology clinical criteria for giant cell arteritis who had not started corticosteroid therapy.1 Patients were randomized to be biopsied at either one to seven days, eight to 29 days, or 30 to 48 days after starting therapy. Only 11 patients were recruited; therefore, no statistical comparisons were made. Overall, nine of the 11 patients had positive biopsies. Five of six biopsies (83%) were positive in patients treated for more than four weeks, whereas four of five (80%) were positive in those treated for less time.

A 1994 large retrospective cohort study assessed the association of temporal artery biopsy results with prior corticosteroid therapy.2 Data from 535 consecutive patients who underwent biopsy for suspected giant cell arteritis were reexamined by experienced pathologists blinded to clinical data, previous corticosteroid therapy, and original pathologic diagnosis. They found a 94% correlation with the original biopsy result (kappa = 0.87). There was no statistical difference in positive biopsy results between patients who had not received corticosteroids before biopsy and those who had (31% vs. 35%; 4% difference; 95% confidence interval [CI], −4.7% to 11.5%; P = .4). A logistic regression model controlling for clinical

Address correspondence to James Haynes, MD, at james.haynes2@erlanger.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Ray-Chaudhuri N, Kiné DA, Tijani SO, et al. Effect of prior steroid treatment on temporal artery biopsy findings in giant cell arteritis. Br J Ophthalmol. 2002;86(5):530–532....

2. Achkar AA, Lie JT, Hunder GG, O'Fallon WM, Gabriel SE. How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med. 1994;120(12):987–992.

3. Narváez J, Bernad B, Roig-Vilaseca D, et al. Influence of previous corticosteroid therapy on temporal artery biopsy yield in giant cell arteritis. Semin Arthritis Rheum. 2007;37(1):13–19.

4. González-López JJ, González-Moraleja J, Burdaspal-Moratilla A, et al. Factors associated to temporal artery biopsy result in suspects of giant cell arteritis: a retrospective, multicenter, case-control study. Acta Ophthalmol. 2012;91(8):763–768.

5. Dasgupta B, Borg FA, Hassan N, et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford). 2010;49(8):1594–1597.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net/?o=1025).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at http://www.aafp.org/afp/fpin.

 

 

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