Temporal Arteritis

McDonnell, Peter J.; Moore, Gary; Miller, Neil R.; Hutchins, GM; Green, W R

doi:10.1016/s0161-6420(86)33706-0

Cited by 110 publications

(13 citation statements)

References 8 publications

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“…Previous attempts to study the level of agreement by different investigators in scoring some histological features in biopsy-proven GCA, such as the extent of inflammation and quantification of giant cells, have been difficult. 23 , 50 In this regard, a poor inter-rater agreement regarding presence/absence of giant cells and granuloma was also found in the validation study. However, our scoring system has demonstrated to be reliable and reproducible when investigators underwent a brief training session of TAB examination.…”

Section: Discussionmentioning

confidence: 80%

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

et al. 2016

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The extent of inflammatory infiltrates in arteries from patients with giant-cell arteritis (GCA) have been described using different terms and definitions. Studies investigating the relationship between GCA histological features and clinical manifestations have produced controversial results. The aims of this study were to characterize and validate histological patterns in temporal artery biopsies (TABs) from GCA patients, to explore additional histological features, including the coexistence of different patterns, and also to investigate the relationship of the inflammatory patterns with clinical and laboratory features.We performed histological examination of TAB from patients with GCA consecutively diagnosed between 1992 and 2012. Patterns of inflammation were defined according to the extent and distribution of inflammatory infiltrates within the artery. Clinical and laboratory variables were recorded. Two external investigators underwent a focused, one-day training session and then independently scored 77 cases. Quadratic-weighted kappa was calculated.TAB from 285 patients (200 female/85 male) were evaluated. Four histological inflammatory patterns were distinguished: 1 – adventitial (n = 16); 2 – adventitial invasive: adventitial involvement with some extension to the muscular layer (n = 21); 3 – concentric bilayer: adventitial and intimal involvement with media layer preservation (n = 52); and 4 – panarteritic (n = 196). Skip lesions were observed in 10% and coexistence of various patterns in 43%. Raw agreement of each external scorer with the gold-standard was 82% and 77% (55% and 46% agreement expected from chance); kappa = 0.82 (95% confidence interval [CI] 0.70–0.95) and 0.79 (95% CI 0.68–0.91). Although abnormalities on temporal artery palpation and the presence of jaw claudication and scalp tenderness tended to occur more frequently in patients with arteries depicting more extensive inflammation, no statistically significant correlations were found between histological patterns and clinical features or laboratory findings.In conclusion, we have described and validated 4 histological patterns. The presence of different coexisting patterns likely reflects sequential steps in the progression of inflammation and injury. No clear relationship was found between these patterns and clinical or laboratory findings. However, several cranial manifestations tended to occur more often in patients with temporal arteries exhibiting panarteritic inflammation. This validated score system may be useful to standardize stratification of histological severity for immunopathology biomarker studies or correlation with imaging.

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Section: Discussionmentioning

confidence: 80%

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

et al. 2016

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“…Persistent arteritis in giant cell arteritis after initiation of glucocorticoid therapy has been noted in several retrospective reports. 10 - 12 McDonnell et al 9 retrospectively evaluated temporal artery biopsies in 237 consecutive patients with varying degrees of elapsed time from initiation of treatment to biopsy and found the longest interval between initiation of therapy and the presence of active arteritis to be 45 days. Those with features of healed arteritis had an average interval of 82 days between starting treatment and temporal artery biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…However in spite of clinical improvement, biopsies often have shown persistent changes of vasculitis. 9 - 12 Such observations suggest some discordance in the systemic and vascular inflammatory components, though systematic studies describing the histopathologic progression of this disease are lacking.…”

Section: Introductionmentioning

confidence: 99%

Clinical and pathological evolution of giant cell arteritis: a prospective study of follow-up temporal artery biopsies in 40 treated patients

et al. 2017

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While clinical signs and symptoms of giant cell arter it is improve promptly after starting glucocorticoid therapy, reports have suggested that the vascular inflammation may persist. To assess the duration and quality of his to pathologic changes in treated patients, we prospectively obtained second temporal artery biopsies in patients treated for 3 to 12 months after their first diagnostic biopsy. 40 patients (28 women, 12 men, median age 77 years) agreed to have a second temporal artery biopsy randomly assigned to 3, 6, 9, or 12 months subsequent to the first. Clinical and laboratory evaluation of the patient cohort revealed a typical rapid response and continued suppression of clinical manifestations as a result of glucocorticoid treatment. His to pathologic findings, evaluated in a blinded fashion by a cardiovascular pathologist, showed unequivocal findings of vasculitis in 7/10 patients with second temporal artery biopsy at 3 months, 9/12 at 6 months, 4/9 at 9 months, and 4/9 at 12 months. Lymphocytes were present in all positive initial biopsies and remained the dominant cell population in chronically treated patients. Granulomatous inflammation decreased in a time-dependent fashion from 78%-100% at initial biopsy to 50% at 9 months and 25% at 12 months. The increased medial fibrosis noted in the second biopsies (60% vs. 33% in primary temporal artery biopsies) suggested that the finding may represent a chronic finding in arteritis. In summary, the response to glucocorticoids in giant cell arteritis was frequently discordant. Clinical manifestations were readily suppressed, but vascular changes were gradual and often incomplete.

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“…A previous study showed that trained pathologists disagreed with the consensus diagnosis of healed arteritis in 26.7–56.7% of cases 10 . Thus, misclassification of atherosclerosis or arteriosclerosis as healed arteritis may have diluted the frequency of inflammatory characteristics and adverse outcomes associated with GCA in this study.…”

Section: Discussionmentioning

confidence: 96%

“…Blinded to the clinical data, a cardiovascular pathologist reviewed the biopsy material (3 hematoxylin and eosin stained slides with 2 intervening elastic Van Gieson stained slides for each case) of the subjects with an initial diagnosis of “healed arteritis.” No widely accepted, standardized definitions for healed arteritis exist, so previously published histological descriptions of healed arteritis were used to recategorize biopsies as “confirmed” or “unconfirmed” healed arteritis 7, 10, 12, 13 . Biopsies that showed an absence of ongoing medial chronic inflammation, but demonstrated fibrosis, attenuation and/or neovascularization of the media, irregular intimal proliferation, multifocal to complete loss of the internal elastic lamina, and adventitial fibrosis and chronic inflammation were categorized as “confirmed healed arteritis” (Table 1, Figure 2).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2011

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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.

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Temporal Arteritis

Cited by 110 publications

References 8 publications

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

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

Clinical and pathological evolution of giant cell arteritis: a prospective study of follow-up temporal artery biopsies in 40 treated patients

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

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