Background/Purpose: Giant Cell Arteritis (GCA) is a systemic vasculitis reportedly more common in Caucasian older adults. Studies suggest that GCA is very rare in African American patients. There is paucity of data on positivity of temporal artery biopsy (TAB) in African American patients. The primary aim of our study is to assess the prevalence of positive TAB in AA patients in a large academic center. Our secondary outcome is to describe the presenting symptoms of GCA in AA patients.

Methods: We conducted retrospective chart reviews of patients who underwent TAB at a large academic health center between 2010 and 2021. Adult patients with self-reported race as AA were included in the study. Analyses were performed using Microsoft Excel.

Results: A total of 77 patients’ charts were reviewed. Only 8 patients (10.4 %) had positive temporal artery biopsies. Their mean age was 79 years. In those patients with positive TAB, headache was reported in all cases, while only 4/8 patients presented with visual symptoms. Additionally, 3/8 patients reported jaw claudication and only 2/8 patients complained of scalp tenderness. The duration of steroid treatment prior to biopsy did not exceed 10 days.

Clinical suspicion was high enough after a multidisciplinary discussion to decide to treat 10/77 patients for GCA despite negative TAB. Vision changes were observed in 7/10 patients. 9/10 patients had elevated erythrocyte sedimentation rate (ESR). Only one patient presented with normal ESR, however, due to vision loss with evidence of ischemic optic neuropathy and concurrent cilioretinal artery occlusion, providers decided to treat for GCA. Notably, one patient had a PET scan that showed increased metabolic activity along the thoracic and abdominal aorta and was subsequently treated for extracranial GCA. In our study, rheumatology was consulted for 76.6% (59/77) of the patients, including all 18 patients who were treated for GCA; 8 with positive biopsies and 10 with negative biopsies.

The mean score for the 2022 ACR/EULAR GCA criteria was 8 among patients who had positive biopsies, while the mean score for GCA probability score (GCAPS) was 13. In contrast, patients with negative biopsies who continued to receive treatment for GCA had average scores on the ACR/EULAR and GCAPS of 5 and 11 respectively. Higher scores of ACR/EULAR and GCAPS were observed in the positive biopsy groups. Among the total cohort of 77 patients, 12 patients had symptoms of Polymyalgia Rheumatica. None of them had positive temporal artery biopsy, however 2 patients were treated as GCA cases despite negative biopsy results per provider high clinical suspicion.

Conclusion: Our study shows that the rate of positive TAB in African Americans is 10.4 % which is higher than 8.4% previously reported in the study by Greuneret al. Headache was found to be the most common presenting symptom of GCA in our cohort. In our study, a total of 23.4% (18 out of 77) of the patients were diagnosed and treated as GCA, 76.6% of them had negative biopsy and were not treated as GCA. Further research is needed to better stratify the risk of temporal artery inflammation in AA patients prior to the decision to pursue TAB.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-retrospective-analysis-of-prevalence-of-positive-temporal-artery-biopsies-in-african-american-patients-with-giant-cell-arteritis-gca-in-a-large-academic-health-center/