Transcript Temporal arteritis

Normal TA
intima
media
adventitia
Bluish curly line
is internal elastic lamina
intima
media
Elastin Von Gieson
(EVG) stained
internal elastic
lamina-normal.
adventitia
media
INTIMA
MEDIA
EVG STAIN
Temporal arteritis
Temporal arteritis
Idiopathic, granulomatous vasculitis of large or medium sized elastic
arteries. SKIP LESIONS
Predilection for superficial temporal artery, but can affect cerebral arteries,
carotids, coronary arteries, aorta, renal arteries etc…
Pathogenesis-actinically damaged elastic tissue-trigger cell-mediated
immune response ? Infection?
Histology-with and without giant cells. Adventitial acute and chronic
inflammation with involvement of media (muscle layer). Fragmentation of
internal elastic lamina.
Giant cells at sites of internal elastic lamina rupture (not always).
Inflammatory oedema of intima, with stenosis of lumen.
American College of Rheumatology
Criteria
Based on the 1990 American College of
Rheumatology criteria for classification of giant
cell arteritis, 3 of the following 5 items must be
present:
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Development of symptoms in patients older than 50
years
New onset of headache or localized head pain
Temporal artery tenderness to palpation
Decreased pulsations not related to arteriosclerosis of
cervical arteries
ESR greater than 50 mm/h
Temporal artery biopsy
No evidence base for how long biopsy should
be. The longer the better as maximises chances
of catching skip lesion.
Target biopsy to painful segment-important.
During handling in pathology lab- serial sections
are cut through the entire specimen (with or
without elastin stains), to increase chance of
picking up skip lesion.
Temporal artery biopsy
Minimum distance between skip lesions =350 microns
(autopsy data).
Positive biopsy rate in pre-steroid cases 30-70 % of
cases (depending on which papers read) (usually 6070%).
Positive biopsy rate after week of steroids-20%-probably
due to decreased sampling efficiency as pain is reduced.
Can detect trans-mural scarring in healed arteritis.
Seeing scarring is not an indication to stop steroids.
Why biopsy ?
Biopsy often done for medicolegal reasons
to confirm diagnosis. Helpful when
positive.
Steroid treatment is not an easy
undertaking....numerous side effects.
Therefore positive biopsy justifies
continued treatment.