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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 / CalculatorPrevalence 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

Finding +LR-LR Comments, Study
Temporal Artery Biopsy Edit inf0.1

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 Edit 10.40.1

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

Finding +LR-LR Comments, Study
Elevated ESR
Duplicate Edit
1.10.2

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 Edit
1.20.4

>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 Edit 4.60.9

in patients with suspected TA

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

Jaw claudication Edit 4.20.7

in patients with suspected TA

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

Diplopia Edit 3.41

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 Edit 2.60.8

in patients with suspected TA

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

Negative Findings

Finding +LR-LR Comments, Study
Synovitis Edit 0.41.1

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 Edit 1.60.9

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 Edit
1.90.8

>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 Edit 1.50.8

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

Weight loss Edit 1.30.9

in patients with suspected TA

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

Headache Edit 1.20.7

(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