Temporal Arteritis: Likelihood Ratios

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 likelihood ratios of findings for Temporal Arteritis are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Temporal Artery Biopsy

inf

0.1

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

10.4

0.1

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

Good Negative Likelihood Ratio

Elevated ESR
Duplicate

1.1

0.2

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

1.2

0.4

>50mm/hr. in patients with suspected TA

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

Good Positive Likelihood Ratio

Finding	+LR	-LR	Comments, Study
Beaded temporal artery	4.6	0.9	in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Jaw claudication	4.2	0.7	in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Diplopia	3.4	1	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	2.6	0.8	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

0.4

1.1

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	+LR	-LR	Comments, Study
Scalp tenderness	1.6	0.9	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	1.9	0.8	>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	1.5	0.8	Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Weight loss	1.3	0.9	in patients with suspected TA Study: JAMA. 2002;287:92-101. http://jama.ama-assn.org/cgi/content/full/287/1/92
Headache	1.2	0.7	(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