TITLE

Initiation of Glucocorticoid Therapy: Before or After Temporal Artery Biopsy?

AUTHOR(S)
Younge, Brian R.; Cook Jr., Briggs E.; Bartley, George B.; Hodge, David O.; Hunder, Gene G.
PUB. DATE
April 2004
SOURCE
Mayo Clinic Proceedings;Apr2004, Vol. 79 Issue 4, p483
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
• Objective: To identify clinical findings in patients with suspected giant cell arteritis (GCA) that may help clinicians decide when to initiate glucocorticoid therapy. • Patients and Methods: Medical diagnostic codes and surgical indexing were used to identify all patients who had temporal artery biopsy at the Mayo Clinic in Rochester, Minn, between January 1, 1988, and December 31, 1997. Patient medical records were abstracted for pertinent clinical data, glucocorticoid use, and final diagnoses. Sensitivities, specificities, predictive values, and likelihood ratios were calculated for the association of the various clinical findings and the presence of a positive biopsy result. Graphic and arithmetic models were constructed to predict positive temporal artery biopsy results. • Results: During the 10-year interval, 1113 patients had temporal artery biopsy. The results were positive for GCA in 373 patients (335%) and negative in 740 (66.5%). Twenty percent of all patients were taking glucocorticoids at the time of biopsy. The presence of jaw claudication had a positive predictive value of 78. Combinations of jaw claudication with new headache, scalp tenderness, and decreased vision had still higher values. Positive likelihood ratios in patients with these combinations and in those with diplopia were greater than 3. A normal erythrocyte sedimentation rate in patients not taking corticosteroids provided a high negative likelihood ratio of 40. An arithmetic equation provided the probability of a positive biopsy result on a continuous scale using 6 variables identified by logistic regression. Patients with a greater than 80% chance of a positive biopsy result and those with less than a 10% chance were identified. • Conclusion: Positive predictive values, likelihood ratios, and an arithmetic formula identify patients who have an increased or decreased chance of a positive temporal artery biopsy result. Use of these methods to determine early initiation of glucocorticoid therapy before temporal artery biopsy or deferral until after biopsy may help reduce both vascular complications of GCA and adverse effects of corticosteroids.
ACCESSION #
12736728

 

Related Articles

  • Etanercept in giant cell arteritis.  // Age & Ageing;Nov2008, Vol. 37 Issue 6, p616 

    The article discusses a study of patients with giant cell arteritis (GCA) on etanercept, a drug that suppresses tumor necrosis factor. Etanercept has been used as a potential alternative to corticosteroids in GCA. After 12 months, patients on etanercept had higher levels of glycemia. GCA was...

  • Incidence of AEs related to glucocorticoids high in GCA.  // Reactions Weekly;1/15/2011, Issue 1334, p4 

    The article focuses on a study in Spain which revealed that a high incidence of adverse events associated with glucocorticoid use was found among patients with giant cell arteritis (GCA), presented at the 74th Annual Scientific Meeting of the American College of Rheumatology and the 45th Annual...

  • CITATIONS AND CLINICIANS' NOTES: NONSTEROIDAL ANTI-INFLAMMATORY DRUGS.  // Current Medical Literature: Rheumatology;2004, Vol. 23 Issue 3, p70 

    Presents clinicians' notes on published articles concerning nonsteroidal anti-inflammatory drugs. "Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis," by G. Nesher, et al, in "Arthritis Rheumatology"; "The effects of nonselective, non-aspirin, nonsteroidal...

  • Visual loss when treating giant cell arteritis. Thomas, D. J. // Practical Neurology (BMJ Publishing Group);Dec2006, Vol. 6 Issue 6, p384 

    The article presents two medical cases which demonstrate the danger of sudden and permanent visual loss in patients being treated for giant cell arteritis. As a result of these two cases, the author now recommends anti-thrombotic treatment combined with steroid therapy in those patients who are...

  • Prednisone.  // Reactions Weekly;6/2/2007, Issue 1154, p20 

    The article presents a case report of neuromyopathies in an elderly patient. An old man started taking oral high-dose prednisone daily for temporal arteritis. He experienced a recurrence of symptoms and received a corticosteroid taper with the use of methotrexate. After a couple of years, he...

  • Temporal artery biopsy – How can we improve performance? McKay, A.; Hussey, K.; Stuart, W.P. // Surgeon (Elsevier Science);Apr2015, Vol. 13 Issue 2, p73 

    Introduction Temporal arteritis is a rare systemic disease of undefined aetiology. The British Society for Rheumatology has issued evidence-based guidance in the form of an investigative algorithm, central to which is biopsy of the superficial temporal artery (TA). Currently in Glasgow these...

  • Does preoperative steroid treatment affect the histology in giant cell (cranial) arteritis? Bury, Danielle; Joseph, Jacob; Dawson, Timothy P. // Journal of Clinical Pathology;Dec2012, Vol. 65 Issue 12, p1138 

    Introduction Giant cell arteritis (GCA) has been successfully treated with steroids for many years and temporal artery biopsy (TAB) is regarded as the gold standard diagnostic test. The primary aim of this study was to determine whether steroid pretreatment abrogates histological features of GCA...

  • Should biopsies be bilateral in temporal arteritis? Lee, Andrew // Ophthalmology Times;12/01/2000, Vol. 25 Issue 23, p9 

    Explores whether temporal artery biopsy (TAB) should be unilateral or bilateral to treat temporal arteritis (TA). Symptoms of TA; Concordance rate of TAB procedures at Wills Eye Hospital; Diagnostic options for TAB.

  • Tocilizumab for giant cell arteritis: an amazing result. Işık, Metin; Kılıç, Levent; Doğan, İsmail; Çalgüneri, Meral // Rheumatology International;Nov2013, Vol. 33 Issue 11, p2961 

    Giant cell arteritis (GCA), previously Horton's disease, is a systemic vasculitis affecting the middle-sized or large arteries in patients older than 50 years of age. The mainstay of the treatment of GCA is glucocorticoid therapy. Herein, we present a case with giant cell arteritis resistant to...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics