Clinical Course and Management of a Consecutive Series of Patients with “Healed Temporal Arteritis”

Abstract

Objectives 1) To describe the clinical course and management of patients with a pathologic diagnosis of “healed” giant cell arteritis; 2) To determine if previously published histological descriptions of healed arteritis can identify patients with a greater likelihood of clinically significant arteritis. Methods All temporal artery biopsy reports between 1994 and 2003 were examined for a diagnosis of “healed arteritis.” Two rheumatologists abstracted the medical record for presenting features, physical findings, co-morbid conditions and data on treatment and outcomes. One pathologist, blinded to the clinical data, reviewed all specimens and re-interpreted the biopsies according to published histological descriptions of healed arteritis. Results Forty-seven patients with an initial pathologic diagnosis of healed arteritis were identified. In 54% of these patients, corticosteroid therapy did not change after the diagnosis of healed arteritis was documented in the pathology report. Seventy percent were ultimately treated with no corticosteroids or low-moderate corticosteroid regimens. Only 32% of the initial cases were confirmed upon review of the biopsies using standardized histological criteria. Patients with confirmed healed arteritis were more likely to have a documented history of polymyalgia rheumatica/giant cell arteritis and a longer duration of steroid treatment before biopsy. These patients were not more likely to have adverse outcomes. Conclusion In this case series, the diagnosis of healed arteritis had little impact on treatment decisions. In most cases, the initial pathologic diagnosis of healed arteritis was not confirmed when biopsies were reviewed by a single pathologist using uniform histological criteria.

Large vessel vasculopathy in a patient with systemic lupus erythematosus: a case report

“…Although accelerated atherosclerosis is a common complication in SLE [12], the pathological findings of the present case did not show atherosclerotic changes such as fatty streak or atheroma [13, 14]. In addition, healed temporal arteritis was less likely to occur in this case as there were no neovascularizations of the media or loss of the internal elastic lamina [15]. Second, we could not speculate regarding the incidence or prevalence of vasculopathy based on the nature of the case reports.…”

Description and Validation of Histological Patterns and Proposal of a Dynamic Model of Inflammatory Infiltration in Giant-cell Arteritis

“…A healing pattern was also observed along with the whole spectrum of active lesions in 3.6% of arteries. Because a healing pattern had been previously reported in patients with delayed biopsies, with or without long-term glucocorticoid treatment, 13 , 22 – 24 , 39 , 44 , 45 the novel finding of healing lesions close to sections showing any type of inflammatory pattern suggests that these scarring changes are part of the evolving reparative process. Healing changes were similarly observed in sequential sections from arteries with panarteritic and adventitial pattern.…”

“…4 However, the healing pattern is sometimes difficult to differentiate from aging or atherosclerotic changes. 4 , 11 , 13 , 21 – 24 …”

Histopathologic Findings of Patients With Biopsy‐Negative Giant Cell Arteritis Compared to Those Without Arteritis: A Population‐Based Study

“…No wall inflammation was observed after the additional sections were cut. The following histopathologic features were evaluated (Figure ): the presence of a mediointimal scar (with focal disappearance of the internal elastic lamina (IEL), medial attenuation (i.e., a localized medial scar with focal disappearance of the media, but with preservation of the IEL), intimal hyperplasia, fragmentation of IEL, calcification, adventitial fibrosis, and neoangiogenesis . In agreement with previous studies, elastic stains in the evaluation of TAB were not used .…”

“…Regardless of whether there is an inflammatory infiltrate, structural changes are often present in the wall of temporal arteries, some of which are sometimes referred to as “healed” or quiescent arteritis . However, if these histologic changes are an expression of GCA, atherosclerosis or the effects of aging is still debated .…”