Background/Purpose: Temporal artery biopsy (TAB) is the gold standard for the diagnosis of Giant Cell Arteritis (GCA), yet is limited by the presence of skip lesions and atypical pathological features. The entity of “healed arteritis” (HA) has been described in the literature as having focal to complete loss of internal elastic lamina, irregular intimal thickening, medial fibrosis or neovascularization, and usually scant, if any, inflammation.We analyzed the treatment patterns and outcomes in patients with a diagnosis of HA on TAB, compared with positive and negative biopsies in patients suspected of GCA.

Methods: We identified 18 patients with TAB pathology report indicating HA, and matched these to 27 with classically positive biopsies (POS), and 29 with negative biopsies (NEG). Statistical analysis compared corticosteroid (CS) management among these 3 cohorts. Changes in CS dose immediately following TAB report were recorded. The 90 day CS requirements were expressed as area under the curve (AUC). Rheumatologists’ pre-biopsy clinical suspicion for GCA, clinical and laboratory parameters, remission rates, and steroid-related adverse events were also analyzed.

Results: In the immediate post-biopsy follow-up period, HA and POS were both less likely to have dose decreases compared to NEG (p<0.001). However, the mean 90 day cumulative steroid dose AUC was significantly lower in HA versus POS (2663 mg vs 4206 mg; p=0.01), and were similar to NEG (2663 mg vs 2088mg; p=0.34). At long term follow up (mean 3.4 +/- 0.41 years), patients with HA tended to more often be in remission (defined as off steroids or tapering with quiescent disease). Both HA and NEG had fewer adverse effects from CS (29 and 14%, respectively) compared to POS (48%) (p=0.02).  When patients with HA were compared to POS, they were significantly more likely to have a low-moderate (vs. high) pre-biopsy clinical index of suspicion for GCA (p=0.0032). Pre-biopsy duration and cumulative CS dose was similar among all groups, as was frequency of polymyalgia rheumatica (PMR). Mean erythrocyte sedimentation rate was significantly higher in the POS group compared to the HA and NEG groups (87 vs. 54 and 66 mm/hr, p=0.023 and 0.01 respectively), while not statistically different between the HA and NEG groups (p=0.32).

Conclusion: Although a report of HA on TAB did not result in immediate reductions in CS, our study shows that ultimately a lower 90 day cumulative dose of CS was utilized in HA. Our data suggests that patients with “healed arteritis” on pathology required less steroid and may be more aggressively tapered without adverse consequence.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-and-outcome-of-patients-with-a-diagnosis-of-healed-arteritis-on-temporal-artery-biopsy/