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A Review of 98 Patients

Walter L. Chmelewski, MD; Kevin M. McKnight, MD; Carlos A. Agudelo, MD; Christopher M. Wise, MD

Arch Intern Med. 1992;152(8):1690-1695.

Abstract
Background.—
Although temporal arteritis is a wellrecognized syndrome, controversy still exists regarding the optimal approach to diagnosis and treatment of this condition. We undertook this review to further define the spectrum of presenting features and outcomes of patients undergoing temporal artery biopsy.

Methods.—
We reviewed the records of all patients undergoing temporal artery biopsy over a 5-year period. Presenting features were compared in biopsy-positive and biopsy-negative patients. In patients with positive biopsy specimens, treatment regimens, disease, treatment-related morbidity, and outcomes were recorded. Alternative diagnoses and therapy were reviewed in biopsy-negative patients.

Results.—
Of 98 patients, 30 had positive and 68 had negative biopsy specimens. Biopsy-positive patients had an increased incidence of headache (93% vs 62%), jaw claudication (50% vs 18%), and prior polymyalgia rheumatica (23% vs 3%), but the sensitivity and specificity of these indicators were relatively low. Other clinical and laboratory parameters, including prior steroids and erythrocyte sedimentation rate, were similar between the two groups. In 30 patients with positive biopsy specimens, response to initial high-dose steroid was excellent. Serious manifestations after initial treatment were not seen, but mild flares were common after 1 year of therapy. Steroid-related morbidity was common, and steroids were seldom discontinued (0/22 patients at 1 year, 6/19 patients at 2 years, 5/11 patients at 3 years). In 68 patients with negative biopsy specimens, alternative diagnoses included neurologic diseases (15 patients), "pure" polymyalgia rheumatica (14 patients), and other inflammatory rheumatologic diseases (10 patients). Fourteen patients with negative biopsy specimens were treated for temporal arteritis, and were similar to biopsypositive patients.

Conclusions.—
Temporal arteritis remains a challenging condition to diagnose and to treat. Presenting features are seldom helpful in predicting biopsy results. Initial treatment is effective but frequently toxic. Although late diseaserelated complications are rare, most patients continue to take long-term low-dose steroid therapy.

(Arch Intern Med. 1992;152:1690-1695)

Author Affiliations
From the Section on Rheumatology, Department of Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC. Drs Chmelewski, McKnight, and Agudelo are now with the North Carolina Arthritis and Allergy Care Center, Raleigh, the Kinston (NC) Internal Medicine, and the Atlanta (Ga) Veterans Administration Hospital and Emory University School of Medicine, respectively.

Footnotes
Accepted for publication February 25, 1992.

Presented at the 55th annual Scientific Session of the American College of Rheumatology, Boston, Mass, November 18, 1991.

Reprint requests to the Section on Rheumatology, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 (Dr Wise).

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