Five-Year Data from the Interdisciplinary Giant-Cell Arteritis Registry at the University Hospital of Würzburg: Value of Temporal Artery Biopsy

Abstract

Background Giant-cell arteritis (GCA) requires immediate diagnosis and therapy. The University Hospital of Würzburg established the Centre for Giant-cell Arteritis (ZeRi) to improve interdisciplinary collaboration.

Aim of the Study Retrospective evaluation of five-year data to assess the clinical relevance of several diagnostic methods, including temporal artery biopsy.

Patients and Methods Retrospective evaluation of 101 patients with suspected GCA who had undergone interdisciplinary examination and biopsy between 2017 and 2022. We analysed specificity and sensitivity in clinical symptoms, ESR, CRP, scalp MRI, temporal artery sonography, and temporal artery biopsy.

Results GCA was diagnosed after completing diagnostic testing in 75 of 101 patients with suspected GCA. By definition, biopsy showed a positive predictive value of 100% and a specificity of 84.6%; however, negative predictive value was 51.2%. Sonography of the temporal artery and MRI showed a positive predictive value of more than 93% and sensitivity of 62.5% and 76.1%, respectively. Clinical symptoms showed the highest sensitivity at 92% with a specificity of 57.7%. ESR and CRP were significantly higher in patients with GCA than in patients without GCA, whereby CRP values showed higher predictive power than did ESR.

Conclusions Most GCA cases can be detected with a precise medical history as well as ESR and CRP assessment. Sonography and MRI on the scalp can usually confirm suspected GCA, only requiring temporal artery biopsy in exceptional cases.

Fazit

Bereits bekannt:

• Bei Verdacht auf eine RZA sollte eine zügige Diagnosesicherung und Therapieeinleitung vorzugsweise in einem interdisziplinären Setting gewährleistet werden.

• Bleibt die Diagnose nach Abschluss der nicht invasiven Untersuchungen weiterhin fraglich, kann unter Berücksichtigung der Invasivität und der hohen Rate falsch negativer Befunde eine Biopsie der A. temporalis erwogen werden.

Neu beschrieben:

• Die Anamnese mit gezielter Nachfrage nach der charakteristischen klinischen Symptomatik sowie die Bestimmung der Entzündungsparameter BSG und CRP haben zusammen eine hohe positive Vorhersagekraft für die Diagnose einer RZA.

• Die Sonografie der A. temporalis und MRT der Kopfschwarte als nicht invasive Untersuchungsverfahren eignen sich mit ihrer hohen Spezifität – insbesondere in Kombination mit dem klinischen Verdacht – als Bestätigungstests, um die Verdachtsdiagnose zu erhärten.

• Die ACR-/EULAR-Klassifikationskriterien können als Instrument zur Klassifizierung einer RZA im klinischen Alltag herangezogen werden.

Conclusion

Already known:

• Suspected GCA requires rapid diagnosis and initiation of treatment, preferably in an interdisciplinary setting.

• Temporal artery biopsy may be considered on inconclusive results from non-invasive examinations while taking the invasiveness and the high rate of false-negative findings into account.

New:

• Taking the patientʼs medical history with targeted inquiries on typical clinical symptoms and testing for ESR and CRP as inflammatory markers together increase positive predictive power in GCA diagnosis.

• Temporal artery sonography and scalp MRI as non-invasive examination procedures with high specificity – especially in combination with clinical suspicion – are suitable for confirming a suspected diagnosis.

• The ACR/EULAR classification criteria may be used in classifying GCA in everyday clinical practice.

Keywords

giant-cell arteritis - anterior ischaemic optic neuropathy - temporal artery biopsy - scalp MRI - temporal artery sonography

Publication History

Received: 15 May 2024

Accepted: 04 August 2024

Article published online:
10 October 2024

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