Biopsy-negative giant cell arteritis: Clinical spectrum and predictive factors for positive temporal artery biopsy

Objectives: To examine the frequency and features of patients with biopsy-n egative giant cell arteritis (GCA), establish differences with biopsy-prove n GCA, and identify the optimal set of predictors for a positive temporal a rtery biopsy (TAB) in patients with GCA. Methods: Retrospective study of an unselected population of patients with G CA diagnosed at the reference hospital for a defined population between 198 1 and 1998. Patients were classified into biopsy-proven GCA if a TAB was po sitive for GCA, or biopsy-negative GCA if they fulfilled the American Colle ge of Rheumatology 1990 criteria far the classification of GCA (Hunder GG, et al Arthritis Rheum 1990; 33:1122-8) despite having a negative TAB. Results: One hundred ninety Caucasian patients were diagnosed with GCA. Twe nty-nine of them (15.3%) had a negative TAB. In these biopsy-negative patie nts, headache and polymyalgia rheumatica were frequent presenting symptoms. In contrast, jaw claudication, abnormal temporal artery on physical examin ation, and constitutional syndrome (asthenia, anorexia, and weight loss of 4 kg or more) were less common. They also had lower biologic markers of inf lammation. The best predictive model of biopsy-proven GCA included a histor y of constitutional syndrome (OR = 6.1), an abnormal temporal artery on phy sical examination (OR = 3.2), and the presence of visual complications (OR = 4.9). Conclusions: In GCA, a subset of patients have a high likelihood of having a negative TAB. This subset seems to have less severe ischemic complication s than that of biopsy-proven GCA. In patients without visual manifestations , abnormal temporal artery on examination or constitutional syndrome the ri sk of having an abnormal TAB is low. Semin Arthritis Rheum 30:249-256. Copy right (C) 2001 by W.B. Saunders Company.