Is temporal artery biopsy a valuable investigation in the management of suspected Giant Cell Arteritis? Experience at an Australian regional centre

Giant cell arteritis (GCA) is an immune-mediated inflammatory condition of large andmedium size vessels, arising predominantly in those over 50 years of age.A rare but significant complication of GCA is permanent vision loss, which may be unilateralor bilateral. It is this potential complication which drives the rationale to treat suspectedGCA swiftly with high dose steroids. Once treatment has commenced, it is recommendedthat histological confirmation of GCA be obtained within 5-7 days. The importance ofconfirming or excluding GCA on histology stems from the desire to avoid unnecessaryadministration of steroids and their associated side effects. Operative intervention is alsonot without risk. In clinical practice, it is unclear whether histological diagnosis (or exclusion)of GCA actually changes ongoing management.The aim of this retrospective study was to determine whether the result of temporal arterybiopsy influenced the ongoing management in cases of suspected GCA, at a regional centreover the past 3 years.Preliminary analysis has identified a cohort of 63 patients who underwent temporal arterybiopsy at Port Macquarie Base Hospital, between January 2016 – December 2018. From thiscohort, forty-seven patients were found to have negative histology for GCA, and more thanhalf of these patients were continued on high-dose steroids regardless.Through further analysis, we intend to explore whether temporal artery biopsy is a valuableinvestigation that influences clinical decision making in the management of suspected GCA.