Fadoul Mikael A, McMackin Katherine K, Patel Raj, Daneshpooy Saba, Tjaden Bruce L, Batista Philip M, Carpenter Jeffrey P, Lombardi Joseph V
Division of Vascular Surgery, Cooper University Hospital, Camden, NJ.
Cooper Medical School of Rowan University, Camden, NJ.
Ann Vasc Surg. 2023 May;92:82-86. doi: 10.1016/j.avsg.2022.12.076. Epub 2023 Jan 4.
Giant cell arteritis (GCA) is a potentially devastating disease that may require treatment with high-dose steroids. Traditionally, diagnosis requires patients to meet at least 3 of 5 clinical criteria, one of which is a positive temporal artery biopsy (TAB). Vascular surgeons are often asked to perform TAB though it is not necessarily required for diagnosis or management. This study aimed to determine if TAB results altered management of patients with a concern for GCA by changing steroid use postoperatively in our health care system.
A retrospective review at a single-center tertiary care hospital was performed between 2007 and 2018. The inclusion criteria were patients greater than 18 years old with complete steroid treatment records who underwent a temporal artery biopsy due to concern for GCA. Steroid use and duration of treatment both pre- and post-operative were collected and analyzed.
Eighty-three of 117 cases reviewed met inclusion criteria. Ninety-one percent (76) of patients had a negative biopsy. Twenty-nine percent (23) of negative biopsies met criteria for GCA prior to biopsy. Of those with a negative biopsy, steroids were continued in 68% (52) of patients after 30 days, 49% (37) after 90 days and 45% (34) after 180 days. Steroids were never started in 11% (6). One patient with a positive biopsy was discontinued on steroids due to intolerance. There was no statistically significant difference in duration of steroids between those with a positive and negative biopsy (average 610 and 787 days respectively; P = 0.682). Average follow up was 33 months.
The duration of steroid use for patients with concern for GCA was not found to be altered by the performance of a TAB at our institution. Given the extremely low yield and absence of impact on steroid duration, TAB is not a useful diagnostic test at our institution. Similar reviews are recommended to determine the utility of TAB at other institutions that may differ in patient population or prescribing practices.
巨细胞动脉炎（GCA）是一种可能具有毁灭性的疾病，可能需要大剂量类固醇治疗。传统上，诊断要求患者满足5项临床标准中的至少3项，其中之一是颞动脉活检（TAB）呈阳性。血管外科医生经常被要求进行TAB，尽管诊断或治疗不一定需要它。本研究旨在确定在我们的医疗系统中，TAB结果是否通过改变术后类固醇的使用来改变对疑似GCA患者的管理。
在2007年至2018年期间对一家单中心三级医院进行了回顾性研究。纳入标准为年龄大于18岁、有完整类固醇治疗记录且因疑似GCA接受颞动脉活检的患者。收集并分析术前和术后类固醇的使用情况及治疗持续时间。
117例回顾病例中有83例符合纳入标准。91%（76例）患者活检结果为阴性。29%（23例）活检阴性的患者在活检前符合GCA标准。在活检阴性的患者中，68%（52例）在30天后继续使用类固醇，49%（37例）在90天后继续使用，45%（34例）在180天后继续使用。11%（6例）从未开始使用类固醇。1例活检阳性的患者因不耐受而停用类固醇。活检阳性和阴性患者的类固醇使用持续时间无统计学显著差异（分别平均为610天和787天；P = 0.682）。平均随访时间为33个月。
在我们机构，对疑似GCA患者使用类固醇的持续时间未因进行TAB而改变。鉴于其极低的阳性率以及对类固醇持续时间无影响，TAB在我们机构不是一项有用的诊断测试。建议进行类似的回顾研究，以确定在患者群体或处方习惯可能不同的其他机构中TAB的效用。
