Alkatan Hind M, AlMana Fawziah, Maktabi Azza M Y
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Front Ophthalmol (Lausanne). 2023 Dec 6;3:1327420. doi: 10.3389/fopht.2023.1327420. eCollection 2023.
Temporal artery (TA) biopsy is commonly used for the diagnosis of giant cell arteritis (GCA). However, a positive biopsy is no longer mandatory for diagnosis. This study aims to correlate the histopathological findings of TA biopsies in suspected cases of GCA to the clinical presentation in an ophthalmic tertiary eye care center to draw useful conclusions and advocate the possible implementation of guidelines for TA biopsy.
Data was collected from patients' medical records including, demographics, clinical data, and histopathological findings and diagnosis. The 2022 American College of Rheumatology/ European Alliance of Associations for Rheumatology (ACR/EULAR) criteria have been used and partially adopted as a guide to compare the variables between TA biopsy-positive and negative groups as well as the TA biopsy-positive group and the group of patients with TA biopsy showing atherosclerosis.
Out of the total 35 patients who underwent a TA biopsy during the period of 23 years, 22.9% of patients had histopathological findings consistent with GCA and 42.9% had TA atherosclerotic changes, while the remaining 34.3% had histologically unremarkable TA. The mean age of all patients was 66 ± 10.9 years. Slightly more than half were females (54.3%) and the remaining were males (45.7%). In the group with positive TA biopsies, the mean age was 71 ± 8.4 years with a higher female predominance (female-to-male ratio of 5:3). The mean diagnostic clinical score used in our study was higher (7.5 ± 2.33) in the GCA-positive group when compared to the other groups with statistical significance (mean of 4.85 ± 2.01 in patients with overall GCA-negative biopsies and 5.13 ± 2.10 in the group with atherosclerosis). Other three clinical variables that were found to be statistically significant in the GCA biopsy-positive group were scalp tenderness, jaw claudication, and optic nerve pallor.
The mean age (71 ± 8.4 years) and the female predominance of GCA in our group of patients with positive TA biopsy (62.5%) was like other reports. In our study 22.9% of performed TA biopsies over the period of the study were positive confirming the diagnosis of GCA on histological exam, which was similar to another report and is considered to be relatively low. The incorporation of increased clinically focused assessments and algorithms, with the aid of the ACR/EULAR criteria, may decrease the frequency of TA biopsies that carries unnecessary cost and risk of procedure-related morbidity. We highly recommend applying the age of ≥ 50 years as an initial criterion for diagnosis, followed by the consideration of the statistically significant clinical features: scalp tenderness, jaw claudication, and optic nerve pallor.
颞动脉（TA）活检常用于巨细胞动脉炎（GCA）的诊断。然而，活检结果呈阳性已不再是诊断的必要条件。本研究旨在将疑似GCA病例的TA活检组织病理学结果与眼科三级医疗中心的临床表现相关联，以得出有用的结论，并倡导可能实施的TA活检指南。
从患者病历中收集数据，包括人口统计学、临床数据、组织病理学结果和诊断。采用并部分采用2022年美国风湿病学会/欧洲风湿病联盟（ACR/EULAR）标准作为指南，比较TA活检阳性和阴性组之间以及TA活检阳性组与TA活检显示动脉粥样硬化的患者组之间的变量。
在23年期间接受TA活检的35例患者中，22.9%的患者组织病理学结果与GCA一致，42.9%有TA动脉粥样硬化改变，其余34.3%的TA组织学表现无异常。所有患者的平均年龄为66±10.9岁。略超过一半为女性（54.3%），其余为男性（45.7%）。在TA活检阳性组中，平均年龄为71±8.4岁，女性占比更高（男女比例为5:3）。与其他组相比，我们研究中使用的平均诊断临床评分在GCA阳性组中更高（7.5±2.33），具有统计学意义（总体GCA活检阴性的患者平均评分为4.85±2.01，动脉粥样硬化组平均评分为5.13±2.10）。在GCA活检阳性组中发现具有统计学意义的其他三个临床变量是头皮压痛、颌部跛行和视神经苍白。
我们TA活检阳性的患者组中GCA的平均年龄（71±8.4岁）和女性占优势（62.5%）与其他报告相似。在我们的研究中，在研究期间进行的TA活检中有22.9%呈阳性，在组织学检查中证实了GCA的诊断，这与另一篇报告相似，且被认为相对较低。借助ACR/EULAR标准纳入更多以临床为重点的评估和算法，可能会减少TA活检的频率，TA活检会带来不必要的成本和与手术相关的发病风险。我们强烈建议将≥50岁作为初始诊断标准，随后考虑具有统计学意义的临床特征：头皮压痛、颌部跛行和视神经苍白。
