Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Significance of Healed Arteritis (HA) on Temporal Artery Biopsy.
Sehgal, Rahul, Belilos, Elise, Geller, Matthew, Ogden, Lorna, E. Carsons, Steven, K. Turi, George
Although temporal artery biopsy (TAB) is the gold standard for the diagnosis of Giant Cell Arteritis (GCA), the presence of skip lesions, and atypical biopsy features limit its utility. In particular, the pathologic diagnosis of HA is controversial. Many changes described for HA may be seen in aging and atherosclerosis alone. We attempted to determine the significance of HA by comparing pathologic features, clinical and laboratory manifestations, and corticosteroid (CS) requirements of HA patients to those displaying classical GCA on TAB.
We performed a retrospective cohort study, comparing the clinical presentation, laboratory data and CS requirements of 8 cases having a pathology report indicating HA to 12 cases of classical GCA. To validate the pathologic impression of HA for our cases, a literature review was performed to identify the pathologic features most commonly reported in HA. These were found to include intimal thickening, medial fibrosis, scarring and calcification and internal elastic lamina (IEL) fragmentation. If present, inflammatory cells must be focal or scant. All slides (~25 sections/patient) were reviewed by 3 pathologists to 1) quantitate the features of HA and GCA and 2) to ensure that any cases with inflammatory infiltrates graded more than scant or focal (01 on a scale of 04) were excluded from the HA group. Clinically, all 20 patients were treated for GCA. CS exposure prior to TAB was also recorded.
Other than the presence of significant medial and/or adventitial inflammation in GCA, there were no significant differences in the pathologic features previously identified to be associated with HA when slides from HA and GCA were compared. Although there was slightly more medial fibrosis, scarring and calcification in the HA group, this was not significant. The proportion of headache, jaw claudication, visual symptoms, fever, weight loss and scalp tenderness did not significantly differ between groups. No difference was noted in ESR. A trend towards higher alkaline phosphatase levels in GCA vs. HA (36% vs. 0%; p=0.11) was seen. Only the presence of PMR was significantly associated with HA (86% vs. 8.3%; p=0.002). Although the mean CS dose at Day 1 was significantly higher for GCA (150mg GCA vs. 45 mg HA; p=0.045), no significant differences in subsequent CS dosing at days 30, 60 or 90 was seen. Importantly, cumulative pre-biopsy CS exposure was nearly identical (357 GCA vs. 366 mg HA; p=0.857).
The presence of only scant or focal inflammation on TAB and a significant association with PMR symptoms were the only pathologic or clinical features that distinguished HA from GCA. CS courses were similar as well. Pre-biopsy CS exposure is not responsible for this phenotype, thus, use of the term "healed arteritis" should be reexamined. "Mild arteritis" may be appropriate for biopsies demonstrating scant or focal inflammation. Intimal thickening, medial fibrosis, scarring and calcification in the absence of any inflammation appear indistinguishable from changes due to aging and atherosclerosis.
To cite this abstract, please use the following information:
Sehgal, Rahul, Belilos, Elise, Geller, Matthew, Ogden, Lorna, E. Carsons, Steven, K. Turi, George; Significance of Healed Arteritis (HA) on Temporal Artery Biopsy. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1311