Temporal Arteritis: Sensitivity and Specificity

Introduction: also known as Giant Cell Arteritis.

The estimated 5-year probability of developing visual loss after initiating corticosteroid therapy was 1%; that of additional visual loss in patients who already had visual loss was 13%.

Symptoms not specific to TA: anorexia, arthralgia, fatigue, fever, temporal headache, myalgia or polymyalgia rheumatica, unilateral vision loss or any visual sx, vertigo

Signs not specific to TA: optic atrophy/neuropathy, fundoscopic abnormality, absent temporal artery pulse, anemia.

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Tags: Autoimmune Vasculitis Tag this Diagnosis.

Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Age < 50	0%	only 2/1435 patients with temporal arteritis were <50. JAMA 2002 Jan 2;287(1):92-101. PMID 11754714
Women	0%	more common than in men
Patients referred for TA biopsy	39%	JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
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The sensitivity and specificity of findings for Temporal Arteritis are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Temporal Artery Biopsy

87.1%

100%

for one biopsy. Sensitivity increases with longer artery segment biopsied, or multiple sites.

specificity assumed to be 100%, as this is the gold standard.

Study: Invest Ophthalmol Vis Sci. 2007 Feb;48(2):675-80. PMID: 17251465

ACR Criteria

94%

91%

in patients with "a" vasculitis.

>=3/5 criteria:

* Age greater than or equal to 50 years at time of disease onset

* Localized headache of new onset

* Tenderness or decreased pulse of the temporal artery

* Erythrocyte sedimentation rate (ESR) greater than 50 mm/h

* Biopsy revealing a necrotizing arteritis with a predominance of mononuclear cells or a granulomatous process with multinucleated giant cells.

Study: Arthritis Rheum 1990 Aug;33(8):1122-8. PMID 2202311

Specific Findings

Finding	Sensitivity	Specificity	Comments, Study
Beaded temporal artery	9%	98%	in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Diplopia	7%	98%	in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Jaw claudication	34%	92%	in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Tender temporal artery	26%	90%	in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Scalp tenderness	17%	90%	in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Synovitis	6%	86%	in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92

Sensitive Findings

Elevated ESR
Duplicate

98%

11%

in patients with suspected TA

Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92

Elevated ESR
Duplicate

92%

24%

>50mm/hr. in patients with suspected TA

Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92

Negative Findings

Synovitis

86%

in patients with suspected TA

Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92

Poorly Diagnostic Findings

Finding	Sensitivity	Specificity	Comments, Study
Elevated ESR Duplicate	35%	82%	>100mm/hr. in patients with suspected TA. Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Temporal Headache	40%	74%	Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Weight loss	35%	73%	in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Headache	72%	40%	(not necessarily temporal.) in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92