Duhaut P, Pinède L, Bornet H, Demolombe-Ragué S, Dumontet C, Ninet J, Loire R, Pasquier J
Department of Internal Medicine, Edouard Herriot Hospital, Lyon, France.
Ann Rheum Dis. 1999 Jun;58(6):335-41. doi: 10.1136/ard.58.6.335.
To assess the clinical features of biopsy proven and negative biopsy temporal arteritis at the time of diagnosis and during a three year follow up.
Newly diagnosed cases of giant cell arteritis were included in a prospective, multicentre study. Initial clinical and biological features, season of diagnosis, and cardiovascular events occurring during the follow up were recorded. Biopsy proven and negative biopsy cases were compared.
Two hundred and seven biopsy proven, and 85 negative biopsy cases were included from 1991 to 1997. Fifty eight per cent of the biopsy proven cases, compared with 39.29% of the negative biopsy cases, were diagnosed during the autumn or winter (p = 0.003). Visual problems (31.5%, v 19.1%, p = 0.031), blindness (9.7% v 2.38%, p = 0.033), jaw claudication (40.8%, v 28.243%, p = 0.044), and temporal artery palpation abnormalities (61.3% v 29.5%, p = 7.10(-7)) were more frequent in the biopsy proven than in the negative biopsy group. Less specific symptoms, such as headache (82.5% v 92. 9%, p = 0.021), or associated polymyalgia rheumatica (40.1% v 65.9%, p = 9 x 10(-5)) were more prevalent in the negative biopsy cases. Biological markers of inflammation were significantly more increased in the biopsy proven group. All cases of blindness occurring after treatment belonged to the biopsy proven group.
Biopsy proven cases seem to be more severe than biopsy negative cases at the time of diagnosis and during follow up. Seasonal difference at diagnosis may suggest a different aetiological pattern.
评估经活检证实及活检阴性的颞动脉炎在诊断时及三年随访期间的临床特征。
新诊断的巨细胞动脉炎病例纳入一项前瞻性多中心研究。记录初始临床和生物学特征、诊断季节以及随访期间发生的心血管事件。对经活检证实和活检阴性的病例进行比较。
1991年至1997年纳入了207例经活检证实的病例和85例活检阴性的病例。经活检证实的病例中有58%在秋季或冬季被诊断，而活检阴性的病例中这一比例为39.29%（p = 0.003）。经活检证实的组中视觉问题（31.5% 对19.1%，p = 0.031）、失明（9.7% 对2.38%，p = 0.033）、颌部跛行（40.8% 对28.243%，p = 0.044）以及颞动脉触诊异常（61.3% 对29.5%，p = 7.10(-7)）比活检阴性组更常见。不太特异的症状，如头痛（82.5% 对92.9%，p = 0.021）或相关的风湿性多肌痛（40.1% 对65.9%，p = 9×10(-5)）在活检阴性的病例中更普遍。经活检证实的组中炎症的生物学标志物显著升高。治疗后发生的所有失明病例均属于经活检证实的组。
经活检证实的病例在诊断时及随访期间似乎比活检阴性的病例更严重。诊断时的季节差异可能提示不同的病因模式。
