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| ==Overview== | | ==Overview== |
| The gold standard for diagnosing temporal arteritis is [[biopsy]], which involves removing of a small part of the [[Blood vessel|vessel]] and examining it microscopically for [[Macrophage|giant cells]] infiltrating the tissue. Since the blood vessels are involved in a patchy pattern, there may be unaffected areas on the [[Blood vessel|vessel]] and the [[biopsy]] might have been taken from these parts. So, a negative result does not definitely rule out the diagnosis. Findings diagnostic of temporal arteritis include skip lesions and normal intervening segments, [[Tunica intima|intimal]] thickening, with prominent [[Cell (biology)|cellular]] infiltration, [[Lymphocyte|lymphocytes]] in the internal or external [[Elastic fiber|elastic]] lamina or [[adventitia]], areas of [[necrosis]] may be present in the arterial wall, [[Granuloma|granulomas]] containing [[Multinucleate|multinucleated]] [[Histiocyte|histiocytic]] and foreign body [[Macrophage|giant cells]], [[T helper cell|helper T-cell]] [[Lymphocyte|lymphocytes]], [[Plasma cell|plasma cells]], and [[Fibroblast|fibroblasts]]. Risks of [[Superficial temporal artery|temporal artery]] [[biopsy]] are temporary or permanent damage to the temporal branch of the [[facial nerve]], [[infection]], [[bleeding]], [[hematoma]], and [[dehiscence]].
| | There are no other diagnostic studies associated with temporal arteritis. |
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| ==Other Diagnostic Studies== | | ==Other Diagnostic Studies== |
| *Temporal artery biopsy may be helpful in the diagnosis of temporal arteritis. Findings diagnostic of temporal arteritis include:<ref name="pmid7728064">{{cite journal| author=Pountain G, Hazleman B| title=ABC of rheumatology. Polymyalgia rheumatica and giant cell arteritis. | journal=BMJ | year= 1995 | volume= 310 | issue= 6986 | pages= 1057-9 | pmid=7728064 | doi= | pmc=2549437 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7728064 }} </ref><ref name="pmid10817557">{{cite journal| author=Weyand CM, Fulbright JW, Hunder GG, Evans JM, Goronzy JJ| title=Treatment of giant cell arteritis: interleukin-6 as a biologic marker of disease activity. | journal=Arthritis Rheum | year= 2000 | volume= 43 | issue= 5 | pages= 1041-8 | pmid=10817557 | doi=10.1002/1529-0131(200005)43:5<1041::AID-ANR12>3.0.CO;2-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10817557 }} </ref>
| | There are no other diagnostic studies associated with temporal arteritis. |
| **Skip lesions and normal intervening segments
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| **Intimal thickening, with prominent cellular infiltration
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| **Lymphocytes in the internal or external elastic lamina or adventitia
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| **Areas of necrosis may be present in the arterial wall
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| **Granulomas containing multinucleated histiocytic and foreign body giant cells, helper T-cell lymphocytes, plasma cells, and fibroblasts<ref name="pmid23523078">{{cite journal| author=Liozon E, Ly KH, Robert PY| title=[Ocular complications of giant cell arteritis]. | journal=Rev Med Interne | year= 2013 | volume= 34 | issue= 7 | pages= 421-30 | pmid=23523078 | doi=10.1016/j.revmed.2013.02.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23523078 }} </ref>
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| *A positive temporal artery biopsy is diagnostic of temporal arteritis with a specificity of 100% and a sensitivity as low as 15% to as high as 87%.<ref name="pmid17251465">{{cite journal| author=Niederkohr RD, Levin LA| title=A Bayesian analysis of the true sensitivity of a temporal artery biopsy. | journal=Invest Ophthalmol Vis Sci | year= 2007 | volume= 48 | issue= 2 | pages= 675-80 | pmid=17251465 | doi=10.1167/iovs.06-1106 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17251465 }} </ref>
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| *Clinical features of severity correlate with the histopathological changes on the temporal artery biopsy.<ref name="pmid7242167">{{cite journal| author=Moya Mir MS, Martín Jiménez T, Barbadillo R, Martín Martín F, Sánchez Ariño A, Magnani E| title=[Giant cell arteritis: diagnostic value of a second biopsy of the temporal artery (author's transl)]. | journal=Med Clin (Barc) | year= 1981 | volume= 76 | issue= 10 | pages= 452-3 | pmid=7242167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7242167 }} </ref>
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| *A positive biopsy after initiation of steroid treatment vary from 10% after 1 week to 86% after 4 or more weeks of treatment.<ref name="pmid7728064">{{cite journal| author=Pountain G, Hazleman B| title=ABC of rheumatology. Polymyalgia rheumatica and giant cell arteritis. | journal=BMJ | year= 1995 | volume= 310 | issue= 6986 | pages= 1057-9 | pmid=7728064 | doi= | pmc=2549437 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7728064 }} </ref><ref name="pmid11973248">{{cite journal| author=Ray-Chaudhuri N, Kiné DA, Tijani SO, Parums DV, Cartlidge N, Strong NP et al.| title=Effect of prior steroid treatment on temporal artery biopsy findings in giant cell arteritis. | journal=Br J Ophthalmol | year= 2002 | volume= 86 | issue= 5 | pages= 530-2 | pmid=11973248 | doi= | pmc=1771122 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11973248 }} </ref>
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| *Most physicians with high clinical suspicion despite an initial negative biopsy would still recommend a second contralateral biopsy, given the consequences of a missed diagnosis of temporal arteritis.<ref name="pmid11567973">{{cite journal| author=Riordan-Eva P, Landau K, O'Day J| title=Temporal artery biopsy in the management of giant cell arteritis with neuro-ophthalmic complications. | journal=Br J Ophthalmol | year= 2001 | volume= 85 | issue= 10 | pages= 1248-51 | pmid=11567973 | doi= | pmc=1723724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11567973 }} </ref>
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| *Risks of temporal artery biopsy are temporary or permanent damage to the temporal branch of the facial nerve, infection, bleeding, hematoma, and dehiscence.
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| ====Video====
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| {{#ev:youtube|yomjRscIxfE}}
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[Category:Needs content]]
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| [[Category:Rheumatology]] | | [[Category:Rheumatology]] |
| [[Category:Ophthalmology]] | | [[Category:Ophthalmology]] |