LETTER
Effect of Previous Corticosteroid Treatment on Temporal Artery Biopsy Results
Antonio A. Achkar, MD;
Gene G. Hunder, MD; and
Sherine E. Gabriel, MD, MSc
1 March 1998 | Volume 128 Issue 5 | Page 410
TO THE EDITOR:
This letter is in response to the letter of Dr. Ruiz-Irastorza [1] commenting on our paper [2], which was published more than 3 years ago. Dr. Ruiz-Irastorza describes our study as "inconclusive"; suggests that in two later reports [3, 4], we refer back to the conclusions of the original study as "unquestionable"; and describes this as "changing conclusions without changing evidence." These statements are incorrect.
We believe that Dr. Ruiz-Irastorza misunderstood certain aspects of our work. We sought to determine the effect of previous corticosteroid treatment on the results of temporal artery biopsy. The study sample comprised 535 patients who underwent temporal artery biopsy at the Mayo Clinic from 1988 to 1991. We determined, from the medical records, whether each patient had received corticosteroid treatment before biopsy. Each biopsy specimen was re-examined by the study pathologist without knowledge of whether steroids had been received before biopsy.
Our main result was that biopsy findings were positive in 31% of patients who did not receive corticosteroids before biopsy and in 35% of patients who received corticosteroids before biopsy (95% CI for the difference in positivity rates, –4.7% to 11.5%). The results did not prove that histologic features are totally unaffected by corticosteroids, but they did show that in a large sample, the positivity rates of temporal artery biopsy were similar in untreated and corticosteroid-treated patients. Temporal artery biopsy may show arteritis even after more than 14 days of corticosteroid treatment in the presence of clinical indications of active disease. These conclusions, as well as the strengths and limitations of our study, were carefully detailed in the original article [2]. All subsequent references to these conclusions were accurate and provided the citation of the original article.
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Author and Article Information
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University of Pittsburgh Medical Center; Pittsburgh, PA 15213
Mayo Clinic; Rochester, MN 55905
1. Ruiz-Irastorza G. Temporal artery biopsy and corticosteroid treatment: changing conclusions without changing evidence [Letter]. Ann Intern Med. 1997; 127:248.
2. Achkar AA, Lie JT, Hunder GG, O'Fallon WM, Gabriel SE. How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med. 1994; 120:987-92.
3. Gabriel SE, O'Fallon WM, Achkar AA, Lie JT, Hunder GG. The use of clinical characteristics to predict the results of temporal artery biopsy among patients with suspected giant cell arteritis. J Rheumatol. 1995; 22:93-6.
4. Lie JT. Histopathologic specificity of systemic vasculitis. Rheum Dis Clin North Am. 1995; 21:883-909.
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