SAT0241 HEALED TEMPORAL ARTERITIS. ANALYSIS OF PATIENTS REFERRED TO RHEUMATOLOGY WITH A DIAGNOSIS OF TEMPORAL ARTERITIS
Authors: Lily Romero Karam, Shruti Agashe, Ileana De Anda-Duran, Ramona Mihu, Jovan Popovich
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The diagnosis of giant cell arteritis (GCA), or temporal arteritis (TA), is a clinical one. Temporal artery biopsy is usually obtained to strengthen support for treatment. Unfortunately a biopsy does not always confirm the diagnosis; results can be reported as active, healed, or negative even in patients with all other features of giant cell arteritis. Histopathologic features suggestive of resolving inflammation are evident in healed TA, but these are non-specific and can also be seen in other conditions that are unlikely to benefit from prolonged steroid treatment. It is not clear if a pathological diagnosis of healed TA helps to support treatment which may be associated with significant toxicity. <h3>Objectives</h3> We analyzed clinical features of patients with "healed" TA and compared them to patients with active and negative biopsies with the goal of identifying any features that may aid treatment decisions. <h3>Methods</h3> Retrospective analysis of 49 patients with established TA diagnosis, seen at a rheumatology practice in Houston, Texas from 8/2007 to 12/2018. Fifty seven percent were referred by Ophthalmology, the rest by other specialties. Patients were divided into 3 groups based on biopsy: Active, Healed, and Negative. Clinical features analyzed at the time of presentation were gender, age of onset, fulfillment of the American College of Rheumatology (ACR) 1990 criteria for the classification of Giant Cell Arteritis and the 2016 revised ACR criteria for early diagnosis of Giant Cell Arteritis (rACR), and the presence of vision abnormalities, headache, temporal artery tenderness/induration, jaw claudication, fever, anemia, sedimentation rate at onset, and flares during follow up. Descriptive data was reported as means ± standard deviation for continuous variables and as proportions for categorical variables; analyzed with ANOVA and chi squared, respectively. Post hoc analysis with Bonferroni corrections and Fisher's exact tests were used. All analyses were performed on Stata version 15 (StataCorp LP, College Station, TX, USA). A p-value of ≤ 0.05 was considered statistically significant. <h3>Results</h3> Thirty-two (65%) of the 49 patients were female and 17 (35%) were male. Biopsy reports showed active disease in 14 (28.5%), healed in 31 (63.3%) and negative in 4 (8.2%) patients. Average age was 72.7 years ±6.3, 73.0 ±9.1, 61.25 ±1.3 years in these 3 groups, respectively (p value 0.008). The Active versus Healed groups were statistically different with respect to age (p 0.028), those meeting ACR and rACR criteria (p 0.029 and p 0.002), and the incidence of jaw claudication: 8 active (57.1%) versus 5 healed (16.1%) patients (p 0.05). There was no statistically significant difference in ophthalmologic manifestations, headache, temporal artery palpation, fever, anemia, and flares. In addition, 90% of patients reported side effects from steroids. <h3>Conclusion</h3> The percent of healed TA was 63.3%, higher than in other studies. Patients with healed TA were less likely to fulfill ACR and rACR criteria for giant cell arteritis. Further studies are needed to identify the subset of patients with healed TA who would have a clear benefit from high dose steroids, that would outweigh the treatment side effects. At the end of the day, the diagnosis of TA remains a clinical one and early involvement of Rheumatology may help avoid unnecessary biopsies and treatment. Ultrasound, MRA, and PET-CT scan may be able to fill the gap when biopsy fails to confirm the diagnosis. <h3>Disclosure of Interests</h3> None declared