Vasculitis
Utility of Erythrocyte Sedimentation Rate and C-Reactive Protein for the Diagnosis of Giant Cell Arteritis

https://doi.org/10.1016/j.semarthrit.2011.10.005Get rights and content

Objectives

To evaluate the utility of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) for the diagnosis of giant cell arteritis (GCA) and to determine the frequency of normal ESR and CRP at diagnosis of GCA.

Methods

All patients undergoing temporal artery biopsy (TAB) between 2000 and 2008 were identified. Only subjects with both ESR and CRP at the time of TAB were included. The medical records of all patients were reviewed.

Results

We included 764 patients (65% women), mean age 72.7 (±9.27) years, who underwent TAB. Biopsy was consistent with GCA in 177 patients (23%). Elevated CRP and elevated ESR provided a sensitivity of 86.9% and 84.1%, respectively, for a positive TAB. The odds ratio of a concordantly elevated ESR and CRP for positive TAB was 3.06 (95% CI 2.03, 4.62), whereas the odds ratio for concordantly normal ESR and CRP was 0.49 (95% CI 0.29, 0.83). Seven patients (4%) with a positive TAB for GCA had a normal ESR and CRP at diagnosis. Compared with GCA patients with elevated markers of inflammation, a greater proportion of these patients had polymyalgia rheumatica symptoms (P = 0.008), whereas constitutional symptoms, anemia and thrombocytosis, were observed less often (P < 0.05).

Conclusions

CRP is a more sensitive marker than ESR for a positive TAB that is diagnostic of GCA. There may be clinical utility in obtaining both tests in the evaluation of patients with suspected GCA. A small proportion of patients with GCA may have normal inflammatory markers at diagnosis.

Section snippets

Patients and Methods

The study was approved by the Mayo Clinic Institutional Review Board. Using the Mayo Clinic database, a data retrieval specialist identified all patients who underwent TAB at our institution between January 1, 2000 and December 31, 2008.

Results

A total of 1106 subjects underwent 1174 TAB at our institution between January 1, 2000 and December 31, 2008. TAB findings were consistent with GCA in 242 patients (21.9%).

Discussion

Biomarkers of inflammation, particularly the ESR and CRP, are often used in the evaluation of patients suspected of having GCA. However, performance of both in the diagnosis of GCA is not well described (5, 6). To our knowledge, the current study is the largest to date that evaluates these markers of inflammation in a cohort of patients undergoing TAB for the diagnosis of GCA. Additionally, we also assessed the frequency and clinical characteristics of patients with biopsy-positive GCA who had

Acknowledgments

Dr Kermani was supported by the Vasculitis Clinical Research Consortium (VCRC), which has received support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (U54AR057319), the National Center for Research Resources (U54 RR019497), and the Office of Rare Diseases Research. The VCRC is part of the Rare Diseases Clinical Research Network (RDCRN).

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