THU0690 Retrospective analysis of temporal artery biopsy and its impact in the management of giant cell arteritis. (12th June 2018)

• Record Type: Journal Article
• Authors: Kasavkar, G.; sinha, A.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 538
• Page End: 539
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.4937
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Prevalence of Giant cell arteritis (GCA) as per primary care data is 17/10000 for patients>55 years of age 1 . British society of rheumatology (BSR) guidelines recommend that suspected cases of GCA should be started on treatment with high dose corticosteroids immediately and then referred for temporal artery biopsy 2 . Temporal artery biopsy has diagnostic yield around 13% 3 . We have done a retrospective analysis of patients who had temporal artery biopsy in order to assess the compliance with BSR guidelines and assess the diagnostic yield. Objectives: To assess the yield of temporal artery biopsy and its impact in the management of Giant cell arteritis Methods: The medical records of patients who had temporal artery biopsy from September 2015 to August 2017 were retrospectively reviewed. We documented demographics, management pre and post biopsy, and timeframes between referral, treatment and biopsy. Data was searched through the clinic letters, referral letters and pathology results. Results: Total number of patients identified was 45. Among them 23 (51%) patients had typical clinical features of GCA and 21 (49%) had atypical features as per the referral letter. Age distribution found was as following: 50 years and below-3; 51 to 60 years- 7; 61 to 70 years- 15; 71 to 80 years-12; 81 to 90 years- 7 and above 90 years-1. Timeframe between biopsy referral and biopsy was as following: within 1 week-27; between 1–2 weeks- 10; between 2–3 weeks- 6 and more than 3 weeks −1. Ophthalmologists performed biopsy for 37 patient and vascular surgeons for 8 patients. Referral was made by primary care for 7 patients, acute medicine for 12 patients, neurology for 3 patients and by rheumatologist for 23 patients. Treatment was initiated in 37 (82%) patients prior to biopsy. Biopsy was positive in 11 (25%) patients, negative in 30 (66%) patients and 4 (8%)showed healed inflammatory changes (HIC). Age distribution of biopsy positive patients was as following - age 61 to 70 years - 4; age 71 to 80 years - 4; age 81 to 90 years - 3. Out of the 11 biopsy positive patients 7 were started on treatment prior to the biopsy and remaining 4 were initiated on treatment after the results. The distribution of duration of treatment before biopsy was as following - within 1 week - 2; between 1 to 2 weeks - 3; between 2 to 3 weeks - 2. Conclusions: - Majority of the patients (80%) had temporal artery biopsy done within 2 weeks of referral - Diagnostic yield of temporal artery biopsy was found nearly twice the existing data - Biopsy was positive in the age group between 61 to 90 years - Positive biopsy was seen up to 3 weeks of treatment with high dose corticosteroids - Duration of treatment pre biopsy and age group appear to impact the diagnostic yield of temporal artery biopsy. References: [1] The Prevalence of Giant Cell Arteritis and Polymyalgia Rheumatica in a UK Primary Care Population- https://doi.org/10.1093/rheumatology/kev088.043 [2] BSR and BHPR guidelines for the management of giant cell arteritis- https://doi.org/10.1093/rheumatology/keq039a [3] Temporal artery biopsy in the diagnosis of giant cell arteritis: Does the end justify the means? 10.1016/j.amsu.2017.06.020 Acknowledgements: Department of rheumatology, Solihull hospital, Heart of England NHS trust Department of pathology, Heart of England NHS trust Disclosure of Interest: None declared