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Parreau S, Liozon E, Chen JJ, Curumthaullee MF, Fauchais AL, Warrington KJ, Ly KH, Weyand CM. Temporal artery biopsy: A technical guide and review of its importance and indications. Surv Ophthalmol 2023; 68:104-112. [PMID: 35995251 PMCID: PMC10044509 DOI: 10.1016/j.survophthal.2022.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 02/01/2023]
Abstract
Temporal artery biopsy (TAB) is a surgical procedure that enables the histological diagnosis of giant cell arteritis (GCA). Performing a TAB requires expertise and a precise approach. Nevertheless, available data supports the value of tissue diagnosis in managing GCA. The current therapeutic recommendation for GCA is long-term glucocorticoid therapy, with an increasing emphasis on the addition of immunosuppressants/biotherapies. Though effective, immunosuppressants and other such biotherapies may put the patient at more risk. Optimizing the diagnosis through tissue evaluation is therefore important in weighing the risks and benefits of initiating therapeutic intervention. We evaluate the evidence supporting the importance of TAB and its indications. We also describe what technical approaches should be used to maximize sensitivity and to avoid possible complications during the procedure.
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Affiliation(s)
- Simon Parreau
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France; Department of Rheumatology, Mayo Clinic, Rochester, MN, USA.
| | - Eric Liozon
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Kim-Heang Ly
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France
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Johannemann A, Proia AD, Criscione-Schreiber L. Mönckeberg sclerosis with giant cells as a masquerade of giant cell arteritis. Eur J Rheumatol 2022; 8:105-108. [PMID: 35929898 PMCID: PMC8133881 DOI: 10.5152/eurjrheum.2021.20134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/21/2020] [Indexed: 09/10/2023] Open
Abstract
Giant cell arteritis (GCA) is the most common type of vasculitis in adults, which is classified as a large/medium vessel vasculitis. It has a predilection for the ophthalmic circulation and extracranial carotid system. Temporal artery biopsy specimens can show the presence of inflammatory multinucleated giant cells. Here, we report just the third case of Mönckeberg sclerosis with multinucleated giant cells affecting the temporal artery and mimicking GCA. This rare finding in the evaluation of a common vasculitis is important for rheumatologists to be aware of and emphasizes close collaboration between clinicians and pathologists.
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Affiliation(s)
- Andrew Johannemann
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alan D. Proia
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
- Department of Pathology, Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Lisa Criscione-Schreiber
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Evangelatos G, Grivas A, Pappa M, Kouna K, Iliopoulos A, Fragoulis GE. Cranial giant cell arteritis mimickers: A masquerade to unveil. Autoimmun Rev 2022; 21:103083. [PMID: 35341973 DOI: 10.1016/j.autrev.2022.103083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
Giant cell arteritis (GCA) is a large-vessel vasculitis that affects cranial and extra-cranial arteries. Extra-cranial GCA presents mainly with non-specific symptoms and the differential diagnosis is very broad, while the cranial form has more typical clinical picture and physicians have a lower threshold for diagnosis and treatment. Although temporal artery biopsy (TAB) has an established role, ultrasound (US) is being increasingly used as the first-line imaging modality in suspected GCA. Vasculitides (especially ANCA-associated), hematological disorders (mainly amyloidosis), neoplasms, infections, atherosclerosis and local disorders can affect the temporal arteries or might mimic the symptoms of cranial GCA and produce US and TAB findings that resemble those of temporal vasculitis. Given that prompt diagnosis is essential and proper treatment varies significantly among these diseases, in this review we aimed to collectively present disorders that can masquerade cranial GCA.
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Affiliation(s)
- Gerasimos Evangelatos
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Alexandros Grivas
- Clinical Immunology-Rheumatology Unit, Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Kouna
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - George E Fragoulis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Calciphylaxis a Giant Cell Arteritis Mimic: A Case Report and Review of the Literature. J Neuroophthalmol 2022; 42:e362-e366. [DOI: 10.1097/wno.0000000000001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Temporal Artery Vascular Diseases. J Clin Med 2022; 11:jcm11010275. [PMID: 35012016 PMCID: PMC8745856 DOI: 10.3390/jcm11010275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023] Open
Abstract
In the presence of temporal arteritis, clinicians often refer to the diagnosis of giant cell arteritis (GCA). However, differential diagnoses should also be evoked because other types of vascular diseases, vasculitis or not, may affect the temporal artery. Among vasculitis, Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is probably the most common, and typically affects the peri-adventitial small vessel of the temporal artery and sometimes mimics giant cell arteritis, however, other symptoms are frequently associated and more specific of ANCA-associated vasculitis prompt a search for ANCA. The Immunoglobulin G4-related disease (IgG4-RD) can cause temporal arteritis as well. Some infections can also affect the temporal artery, primarily an infection caused by the varicella-zoster virus (VZV), which has an arterial tropism that may play a role in triggering giant cell arteritis. Drugs, mainly checkpoint inhibitors that are used to treat cancer, can also trigger giant cell arteritis. Furthermore, the temporal artery can be affected by diseases other than vasculitis such as atherosclerosis, calcyphilaxis, aneurysm, or arteriovenous fistula. In this review, these different diseases affecting the temporal artery are described.
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Comments on a Case Entitled "Gazing Into the Crystal Ball". J Neuroophthalmol 2021; 42:e536-e537. [PMID: 34860743 DOI: 10.1097/wno.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cherayil NR, Scoles D, Moran AM, Elder DE, Tamhankar MA. Gazing Into the Crystal Ball: Calciphylaxis Causing Striking Retinal Vascular Calcification, Ocular Ischemic Syndrome, Crystalline Retinopathy, and Ischemic Optic Neuropathy. J Neuroophthalmol 2020; 41:e212-e214. [PMID: 33105406 DOI: 10.1097/wno.0000000000001090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 72-year-old woman with membranous glomerulonephritis and failed renal transplant on peritoneal dialysis presented with bilateral vision loss. She reported several months of diminishing right eye vision that worsened after cataract extraction. On presentation, visual acuity was hand motion in the right and 20/100 in the left eye with a right afferent pupillary defect. Confrontation visual fields were constricted bilaterally. Intraocular pressure was 23 in the right eye, and there was diffuse right eye central corneal opacity with iris neovascularization. Fundus examination revealed bilateral pale optic nerves with cotton wool spot inferior to the left optic disc and diffuse arteriolar whitening with crystalline deposits in the left macula. Given fundus appearance, concurrent ischemic optic neuropathy, and ocular ischemic syndrome, ocular calciphylaxis was suspected. The patient reported development of painful gluteal nodules a month prior, and biopsy revealed calcinosis cutis, a dermatopathologic finding on the spectrum of calcific vasculitides. Her vision continued to decline in both eyes with left eye vision of 20/400. Intravenous sodium thiosulfate through hemodialysis was started with initial improvement in left eye vision to 20/125, but subsequently declined despite treatment. Pathogenesis of systemic calciphylaxis is poorly understood but believed to result from upregulation of osteogenesis and decreased inhibition of vascular calcification in parathyroid axis dyscrasias due to end-stage renal disease. Excess serum calcium-phosphate deposits in blood vessels causing tissue infarction, most commonly in the skin. Prior case reports have described ischemic optic neuropathy mimicking giant cell arteritis and crystalline retinopathy with ocular ischemic syndrome separately. Treatment with empiric intravenous sodium thiosulfate and calcium chelation may preserve vision in some patients.
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Affiliation(s)
- Neena R Cherayil
- Department of Neurology (NRC, MAT), University of Pennsylvania, Philadelphia, Pennsylvania; Department of Ophthalmology (NRC, DS, MAT), Scheie Eye Institute, Philadelphia, Pennsylvania; and Department of Pathology (AMM, DEE), University of Pennsylvania, Philadelphia, Pennsylvania
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Ing EB, Wang DN, Kirubarajan A, Benard-Seguin E, Ma J, Farmer JP, Belliveau MJ, Sholohov G, Torun N. Systematic Review of the Yield of Temporal Artery Biopsy for Suspected Giant Cell Arteritis. Neuroophthalmology 2019; 43:18-25. [PMID: 30723520 PMCID: PMC6351023 DOI: 10.1080/01658107.2018.1474372] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To determine the positive yield (utility rate) of temporal artery biopsy (TAB) in patients with suspected giant cell arteritis (GCA). STUDY DESIGN Systematic review (CRD42017078508) and meta-regression. MATERIALS AND METHODS All articles concerning TAB for suspected GCA with English language abstracts from 1998 to 2017 were retrieved. Articles were excluded if they exclusively reported positive TAB, or only cases of known GCA. Where available, the pre-specified predictors of age, sex, vision symptoms, jaw claudication, duration of steroid treatment prior to TAB, specimen length, bilateral TAB, and use of ultrasound/MRI (imaging) were recorded for meta-regression. RESULTS One hundred and thirteen articles met eligibility criteria. The I 2 was 92%, and with such high heterogeneity, meta-analysis is unsuitable. The median yield of TAB was 0.25 (95% confidence interval 0.21 to 0.27), with interquartile range 0.17 to 0.34. On univariate meta-regression age (coefficient 0.012, p = 0.025) was the only statistically significant patient factor associated with TAB yield. CONCLUSIONS Systematic review revealed high heterogeneity in the yield of TAB. The median utility rate of 25% and its interquartile range provides a benchmark for decisions regarding the under/overutilization of TAB and aids in the evaluation of non-invasive alternatives for the investigation of GCA.
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Affiliation(s)
- Edsel B. Ing
- University of Toronto Ophthalmology, Michael Garron Hospital, University of Toronto, Toronto, Canada
| | - Dan Ni Wang
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Jingyi Ma
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - James P. Farmer
- Department of Ophthalmology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
- Anatomic Pathology, University of Ottawa and Queens University, Ottawa, Canada
| | - Michel J. Belliveau
- Department of Ophthalmology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Nurhan Torun
- Harvard University Ophthalmology, Beth Israel Deaconness, Boston, Massachusetts, USA
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Farooqui S, Chan A, Cullen JF, Milea D. Too Young to Undergo Temporal Artery Biopsy? Calciphylaxis-Related Anterior Ischemic Optic Neuropathy. Neuroophthalmology 2018; 43:252-255. [PMID: 31528191 DOI: 10.1080/01658107.2018.1493739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/11/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022] Open
Abstract
A 39-year-old male patient with end-stage renal failure presented with unexplained isolated unilateral anterior ischemic optic neuropathy, high sedimentation rate, and high CRP. Despite the relatively young age of the patient, an ipsilateral temporal artery biopsy was performed, disclosing calciphylaxis, a highly morbid condition associated with end-stage renal failure, which requires urgent, specific management.
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Affiliation(s)
- S Farooqui
- Ophthalmology Department, Singapore National Eye Centre, Singapore
| | - Asy Chan
- Ophthalmology Department, Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - J F Cullen
- Ophthalmology Department, Singapore National Eye Centre, Singapore
| | - D Milea
- Ophthalmology Department, Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Graduate Medical School, Singapore
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