How would you interpret a temporal artery biopsy demonstrating focal chronic inflammation in the adventitia associated with small adventitial vessels and nerves without inflammation of the intima and media and without giant cells?

Topics: Rheumatology • Vasculitis • GCA • Neurology • Neuro-Ophthalmology

Answer from: at Academic Institution

This is a question that encompasses decades-old confusion and controversial advice generated by innumerable rheumatologists, pathologists, and peer-reviewed publications on this topic. The controversy is compounded when one considers the heterogeneity (and sometimes paucity) of clinical, laboratory,...

Comments

at Solo Practice
Very nice summary of a confusing topic. Thank you.

Answer from: at Community Practice

Peri-adventitial inflammation seen in temporal artery biopsies is generally a non-specific finding. This was demonstrated nicely in a recent histopathological study from Mayo Clinic evaluating temporal artery samples from autopsy cases. Over 40% of temporal arteries from older individuals (with no h...

Answer from: at Academic Institution

I agree with Dr. @Brawer's comments. For decades, in rheumatology, we have been arguing what to do for patients with "clinically pure PMR" in whom GCA findings are seen in a blind (no pun intended) TA biopsy. Reportedly, in the US, 1 in 10 patients with clinically pure PMR will have a positive TA bi...

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