ACR Meeting Abstracts

ACR Meeting Abstracts

  • Home
  • Meetings Archive
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP PRSYM
    • 2016-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • Meeting Resource Center

Abstract Number: 793

Preliminary Analysis of Histological Findings in Diagnosis of Giant Cell Arteritis Biopsy Positive Patients

Surjeet Singh1, Andrew Hutchings2, Wulf Forrester-Barker3, Bhaskar Dasgupta4, Andreas P. Diamantopoulos5, Peter Lanyon6, Malgorzata Magliano7, Brendan McDonald8, Konrad Wolfe9 and Raashid Luqmani10, 1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, 2Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom, 3University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom, 4Department of Rheumatology, Southend University Hospital, Essex, United Kingdom, 5Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway, 6Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, 7Department of Rheumatology,, Stoke Mandeville Hospital, Aylesbury, United Kingdom, 8Department of Pathology, John Radcliffe Hospital, Oxford, United Kingdom, 9Department of Pathology, Southend University Hospital, Essex, United Kingdom, 10Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: biopsies, giant cell arteritis, histopathologic, temporal arteritis and vasculitis

  • Tweet
  • Email
  • Print
Session Information

Session Title: Vasculitis

Session Type: Abstract Submissions (ACR)

Background/Purpose

A positive temporal artery biopsy (TAB) with giant cells, active inflammation and intimal hyperplasia is the gold standard test for diagnosing temporal arteritis. However, a negative TAB does not rule out the disease. In this preliminary analysis we have looked at the histological features of the TAB’s assessed in a prospective multicentre study of patients with suspected temporal arteritis (TABUL).

Methods

Temporal artery biopsies were performed in all patients with suspected temporal arteritis from June 2010 to December 2013. All biopsies were taken from the symptomatic side and examined by the local pathologist, recording results on a standardised case report form in addition to a routine pathology report. We describe the key histological features in the intima and internal elastic lamina, the presence of inflammatory infiltrates (including giant cells), thrombus, occlusion and recanalisation. Age, sex, median time to biopsy from starting steroids, biopsy length and clinical diagnosis at baseline assessment were recorded. 

Results

In this preliminary analysis, data was available from 350 patients (254 female: 86 male, mean age = 71.1±9.5 (SD), [range 47-96]), of whom 348 received steroids. The mean time to biopsy following initiation of steroids was 5±3 (SD) days with 6 GCA biopsy positive cases greater than 10 days.  The mean length of the temporal artery biopsy was 11.9±7.4 (SD) mm. Only 332 biopsies consisted of an artery (94.9%), from which 89 cases were positive for GCA (26.8%). Of the 89 cases, 69 had internal hyperplasia and 11 had both internal hyperplasia and arteriosclerosis in the intima. Fragmentation in the internal elastic lamina was reported in 53 cases, 24 cases reported both fragmentation and reduplication. In 98.9% of GCA biopsy positive cases, inflammatory infiltrate were present, with transmural (41.6%) and adventitia (18.0%) recorded as the predominant sites of inflammation. Giant cells were seen in 67 (75.3%) of GCA biopsy positive cases. Completely occluded vessels were found in 20 cases, usually due to internal hyperplasia (in 16), although 4 cases had additional thrombus. Furthermore, 7 cases had evidence of recanalisation in at least one section of the biopsy. We analysed the clinician’s initial assessment at baseline (prior to biopsy): 88, 189 and 73 out of 350 cases were defined as possible, probable or definite GCA: of these, 7 (8.0%), 45 (23.8%) and 37 (50.7%) respectively had a biopsy consistent with GCA.  

Conclusion

Histological features in biopsy positive patients with GCA are not confined to one particular form of inflammation.  The most common finding was transmural inflammation. We report a relatively low number of positive biopsies (89/350) which may reflect the low index of suspicion of GCA in this group, technical difficulties in obtaining an adequate sample, or skip lesions missed due to inadequate length of tissue, or the effects of glucocorticoid therapy in changing the biopsy result.  Our findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis.


Disclosure:

S. Singh,
None;

A. Hutchings,
None;

W. Forrester-Barker,
None;

B. Dasgupta,
None;

A. P. Diamantopoulos,
None;

P. Lanyon,
None;

M. Magliano,
None;

B. McDonald,
None;

K. Wolfe,
None;

R. Luqmani,
None.

  • Tweet
  • Email
  • Print

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/preliminary-analysis-of-histological-findings-in-diagnosis-of-giant-cell-arteritis-biopsy-positive-patients/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

ACR Pediatric Rheumatology Symposium 2020

© COPYRIGHT 2022 AMERICAN COLLEGE OF RHEUMATOLOGY

Wiley

  • Home
  • Meetings Archive
  • Advanced Search
  • Meeting Resource Center
  • Online Journal
  • Privacy Policy
  • Permissions Policies