Clinical StudiesRisk Factors and Predictive Models of Giant Cell Arteritis in Polymyalgia Rheumatica
Section snippets
Patients
We included all patients with polymyalgia rheumatica, either primary or associated with an underlying GCA, treated by the Rheumatology Divisions of these Hospitals during the following periods: January 1975 to January 1993 (Hospital M. Valdecilla), June 1978 to January 1993 (H.N.S. Aranzazu), and June 1981 to January 1993 (H. Xeral). During most of the time, these services had been the only providers of rheumatological care in the three provinces and therefore, this population can be regarded
General Features and Risk Factors for an Abnormal Temporal Artery Biopsy
There was a predominance of women in both groups (92 females/45 males in group A versus 60 females/30 males in group B). As shown in Table 1, patients with GCA were characterized by an older age at disease onset (72.8 ± 5.8 versus 69.7 ± 7.7 years, P < 0.002), higher proportion of cases with cranial symptoms (P < 0.0001 for all of them), and a lower frequency of synovitis (P = 0.006). Moreover, the temporal artery abnormalities were clinically far less evident in the group with polymyalgia
Discussion
The diagnosis of GCA can only be made definitively by demonstrating the characteristic histological abnormalities on temporal artery.[14] Because of the increased awareness of the syndrome, more biopsies are being done, with decreasing positive rates, as low as 11% in recent reports.[15] The goals of our study were to identify the best predictors of a positive temporal artery biopsy and to generate predictive models with either a high or low probability of GCA. There have been several attempts
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Cited by (74)
Clinical predictors of positive temporal artery biopsy
2016, Canadian Journal of OphthalmologyManagement of giant cell arteritis: Recommendations of the French Study Group for Large Vessel Vasculitis (GEFA)
2016, Revue de Medecine InterneCitation Excerpt :Another study showed that headaches (86%), claudication of the jaw (42%) and temporal artery abnormalities on physical examination (44%) significantly increased the probability of TAB-positive GCA (relative risk: 3.6, 2.9 and 2.5, respectively) [14]. In the presence of polymyalgia rheumatica, the association of recent onset headaches, claudication of the jaw and a clinical temporal artery anomaly confer a positive predictive value of 97% and positive likelihood ratio of 47 to support a diagnosis of GCA; disease onset after 70 years of age increased the positive predictive value to 100%, but this association was seen in only 27% of the patients with polymyalgia rheumatica [15]. Comments: although not supported by study results, tongue [16] or scalp necrosis [17] and acute ischemic visual disorders are probably also strongly suggestive of GCA.
Prevalence of ischemic complications in patients with giant cell arteritis presenting with apparently isolated polymyalgia rheumatica
2015, Seminars in Arthritis and RheumatismCitation Excerpt :Several investigators have suggested that this has a low risk of suffering GCA-related ischemic events [8–14]. However, other studies that have analyzed this issue report conflicting results [6,7,15–17]. In support of the hypothesis that these patients represent a high-risk subset, we have recently attended several cases of patients with GCA presenting with apparently isolated PMR who developed severe ischemic complications and other vascular complications, such as aortic involvement.
Predictors of positive temporal artery biopsy in patients with giant cell arteritis and polymyalgia rheumatica (comment on the article by Marí et al.)
2010, European Journal of Internal MedicineAnalysis of temporal artery biopsies in an 18-year period at a community hospital
2009, European Journal of Internal MedicineCitation Excerpt :However, we did not find a clinical utility on this fact. In the group with the final diagnosis of PMR, the percentage of patients with cranial symptoms was high; indeed, the cranial symptoms were probably the reason for performing the biopsy in these cases, in whom it is mandatory to rule out the coexistence of GCA [25]. The number of patients in the TAB− group with a different final diagnosis, and the absence of new cases of GCA during follow-up suggest that the patients were correctly diagnosed in spite of the negative result.
Biomarkers as predicting factors for relapse in polymyalgia rheumatica: The importance of alkaline phosphatase
2023, Rheumatology (United Kingdom)