Shahriar Amjadi, Ali Haider, Joshua Anderson
Background: Giant cell arteritis (GCA) is a systemic vasculitis involving medium and large arteries and can lead to irreversible blindness. Though a tempo- ral artery biopsy (TAB) remains the gold standard in diagnosis, clinical presentation and laboratory investigations are also vital in diagnosis.
Benchmarking: A TAB length of at least 20 mm has been shown to decrease the likelihood of false negatives. Elevated inﬂammatory markers, espe- cially ESR (>50 mm/hr), CRP (>8 mg/L) and plate- lets (> 400×109/L), are considered hallmarks of the disease.
Methods: A retrospective case note audit was per- formed reviewing patients who had a TAB from 2007 to 2016, inclusive, at John Hunter Hospital, Newcastle, NSW. The TAB positivity, lengths, inﬂammatory markers (ESR, CRP, white cell count and platelets) were recorded as well signs and symptoms including headache, jaw claudication and the presence of polymyalgia rheumatica (PMR).
Results: 180 TABs were undertaken. 22.1% were positive for GCA (n = 40). Of the TAB positive and negative cohorts, there was a statistically signiﬁcant difference in ESR (64.3 vs 46.9 mm/hr), CRP (93.9 vs 46.6 mg/L) and platelet counts (362.2 vs 288.3 × 109/L) (P < 0.05) but not of percentage of biopsies greater than or equal to 20 mm (22.7% vs 22.2%). There was no statistical difference in the percentage of patients with PMR, headache or jaw claudication. Conclusions: In patients where GCA is suspected clinically, elevated inﬂammatory markers may negate the requirement of a temporal artery biopsy. However, longer biopsies should be performed to reduce the likelihood of a false negative.
COMPARISON OF RANIBIZUMAB AND AFLIBERCEPT IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION TREATED FOLLOWING A ?TREAT AND EXTEND? PROTOCOL: EFFICACY VARIABLES FROM THE PRE-SPECIFIED 12- MONTH INTERIM ANALYSIS OF THE RIVAL STUDY