DOES
THIS PATIENT HAVE TEMPORAL ARTERITIS?
Smetana
GW, Shmerling RH. JAMA 2002 Jan 2;287(1):92-101.
CONTEXT:
Clinicians must be able to confidently diagnose temporal arteritis (TA), since
failure to make a correct diagnosis may lead to irreversible visual loss as
well as inappropriate evaluation and treatment of headache, fatigue, and other
potential presenting symptoms. The diagnostic value of particular signs and
symptoms among patients with suspected TA is unknown.
OBJECTIVE:
To determine the accuracy of historical features, physical examination, and
erythrocyte sedimentation rate (ESR) in diagnosis of TA.
DATA
SOURCES: We performed a MEDLINE search of English-language articles published
between January 1966 and July 2000 and a hand search of bibliographies of
retrieved articles, previous reviews, monographs, and textbooks.
STUDY
SELECTION: Studies that provided detailed clinical information on patients who
had been referred for temporal artery biopsy. Of 114 studies retrieved, 41 met
our inclusion criteria; 21 included both biopsy-positive and biopsy-negative
patients and formed the core of our review.
DATA
EXTRACTION: Both authors independently reviewed each study to determine
eligibility, abstracted data using a standardized instrument, and classified
study quality using predetermined criteria.
DATA
SYNTHESIS: The prevalence of TA in the general population is less than 1%.
However, in our 21 core studies, 39% of patients referred for temporal artery
biopsy had positive results. The only 2 historical features that substantially
increased the likelihood of TA among patients referred for biopsy were jaw
claudication (positive likelihood ratio [LR], 4.2; 95% confidence interval
[CI], 2.8-6.2) and diplopia (positive LR, 3.4; 95% CI, 1.3-8.6). The absence of
any temporal artery abnormality was the only clinical factor that modestly
reduced the likelihood of disease (negative LR, 0.53; 95% CI, 0.38-0.75).
Predictive physical findings included temporal artery beading (positive LR,
4.6; 95% CI, 1.1-18.4), prominence (positive LR, 4.3; 95% CI, 2.1-8.9), and
tenderness (positive LR, 2.6; 95% CI, 1.9-3.7). Normal ESR values indicated
much less likelihood of disease (negative LR for abnormal ESR, 0.2; 95% CI,
0.08-0.51).
CONCLUSIONS:
A small number of clinical features are helpful in predicting the likelihood of
a positive temporal artery biopsy among patients with a clinical suspicion of
disease; the most useful finding is a normal ESR, which makes TA unlikely.
PREDICTIVE
CLINICAL AND LABORATORY FACTORS IN THE DIAGNOSIS OF TEMPORAL ARTERITIS.
Mohamed
MS, Bates T. Ann R Coll Surg Engl 2002 Jan;84(1):7-9.
BACKGROUND:
Surgeons are frequently called upon to perform temporal artery biopsy in
patients suspected of having temporal arteritis. In this study, we have
attempted to identify clinical and laboratory features that may predict the
results of temporal artery biopsy for the diagnosis of temporal arteritis.
DESIGN:
The medical records of patients undergoing temporal artery biopsy over a
10-year period in one hospital were reviewed. Details of presenting features
were recorded and comparisons made between biopsy-positive and biopsy-negative
patients.
RESULTS:
Of 59 patients who underwent temporal artery biopsy, the records of 51 patients
were located. Of these, 17 patients had positive biopsy specimens and 33 had
negative biopsies. In one patient, no temporal artery was found in the biopsy
specimen. In the biopsy-positive patients, 69% had an erythrocyte sedimentation
rate of greater than 50 mm/h compared to 31% of biopsy negative patients (P =
0.03).
CONCLUSION:
With regard to the other clinical and laboratory parameters that were
evaluated, no statistically significant differences were found between
biopsy-positive and biopsy-negative patients. The most useful laboratory evaluation
is the erythrocyte sedimentation rate.