Temporal artery morphology and morphometry in giant cell arteritis.

Paraffin sections and more than 7,000 plastic cross-sections of temporal arteries from 27 patients with a clinical diagnosis of polymyalgia rheumatica (PMR), 16 patients with a clinical diagnosis of temporal arteritis (TA) and 18 age- and sex-matched postmortem controls were studied using light microscopy. A new method was developed to permit a morphometric comparison between biopsies and autopsy specimens. Two stages of inflammation were discerned in TA. In atrophic arterial segments there was a focal, foreign-body, giant-cell reaction to the calcified internal elastic membrane (IEM) with a spatially correlated, mononuclear cell infiltration. Isolated giant cells were also found to attack the IEM in these cases. The majority of the biopsies displayed a different picture with a diffuse macrophage attack on media and intima with numerous and apparently macrophage-derived giant cells, which did not attack calcifications. The latter arteries were significantly widened (p less than 0.02), which indicates that this phase is the later one. Non-inflamed segments of PMR vessels displayed a significant, non-reactive media atrophy compared with controls (p less than 0.03) and their IEM calcifications were significantly larger (p less than 0.02). The circumference was smaller in atrophic PMR arteries than in inflamed TA arteries (p less than 0.006), which contradicts post-inflammatory scarring.