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Introduction
Giant cell arteritis (GCA) primarily affects medium-sized vessels of the head, and steroids have been the foundation of its treatment for many years. While most symptoms can be vague and non-specific (eg, headache), its early recognition and management can be crucial to avoiding the onset of blindness in affected patients. The gold standard diagnostic test is generally considered to be histological examination of a temporal artery biopsy (TAB), although this can be compromised by false negative results owing to the skip lesion nature of GCA. Histologically, there are a variety of features including intimal proliferation with giant cells, evidence of elastic lamina damage and periarterial lymphocytic infiltration ( figure 1 ). 1
Prolonged high-dose steroid treatment is not without risk, 2 so a positive biopsy provides additional justification over clinical findings alone. Anecdotal pathological experience has led one of the authors to believe that the use of steroids within 2 weeks of biopsy is highly likely to cause regression of the classic GCA histological features, rendering such biopsies non-diagnostic. This study was conducted to inform anecdotal experience with evidence and add the results of a large cohort study to the limited literature on the subject.
Materials and methods
A retrospective search was conducted of all patients at Lancashire Teaching Hospitals NHS Trust who underwent TAB between 1 January 2005 and 21 January 2011, which resulted in 112 biopsies from 111 patients (one patient had two biopsies and both were included). Medical case notes where then studied to find the position and date of the biopsy as well as the duration, dosage and route of steroids if given. Where there was no comment or prescription, it was assumed that steroids were not being taken at the time of the biopsy. Electronic patient data were used to determine the erythrocyte sedimentation rate (ESR) as close as possible to the date of presentation or biopsy if the former was not available. Pathology reports were used to determine the histological outcome. Any signs of inflammation, including signs suggestive of healed arteritis, were determined to be positive for GCA as the biopsy was not conclusively negative; this affected eight results. Owing to the small numbers involved, the results were analysed using the Fisher exact test in Stata 11.
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