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Of 98 patients,30 had positive and 68 had negative biopsy specimens. Biopsy-positive patients had an increased incidence of headache(93%vs 62%),jaw claudication(50%vs 18%),and prior polymyalgia rheumatica(23%vs 3%),but the sensitivity and specificity of these indicators were relatively low.Other clinical and laboratory parameters,including prior steroids and erthrocyte sedimentation rate,were similar between the two groups.In 30 patients with positive biopsy specimens,response to initial high-dose steroid was excellent.Serious manifestations after initial treatment were not seen,but mild flares were common after 1 year of therapy.Steroid-related morbidity was common,and steroids were seldom discontinued(o/22 patients at one year,6/19 patients at 2 years,5/11 patients at 3 years).In 68 patients with negative biopsy specimens, alternative diagnoses included neurologic diseases(15 patients),"pure" polymyalgia rheumatica(14 patients),and other inflammatory rheumatological diseases(10 patients).Fourteen patients with negative biopsy specimens were treated for temporal arthritis,and were similar to biopsy-positive patients.Temporal arthritis remains a challenging condition to diagnose and to treat.Presenting features are seldom helpful in predicting biopsy results.Initial treatment is effective but frequently toxic.Although late disease-related complications are rare,most patients continue to take long-term steroid therapy. |
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arteritis,temporal
headache
jaw claudication
neurologic symptoms
polymyalgia rheumatica
prognosis
sedimentation rate
sedimentation rate,elevated
steroid therapy,CNS treatment and complications with
temporal artery,biopsy
temporal artery,tender
treatment of neurologic disorder
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