Presenting Features of Giant Cell Arteritis with Active Versus Healed Arteritis on Biopsy

Giant cell arteritis (GCA) is often categorised as ”active” or ”healed” on temporal artery biopsy (TAB). The purpose of this study was to compare the initial clinical presentation of patients with GCA according to active versus healed arteritis on TAB. A retrospective chart review was performed for patients with biopsy-proven GCA (BP-GCA) at a single academic medical institution from a previously reported cohort. The arteritis on TAB was categorised as “active” or “healed” based on the pathological reports. Demographic information, clinical presentation, past medical history, and test results were collected from the date of TAB. These baseline characteristics were entered into the GCA Risk Calculator. Of 85 patients with BP-GCA, 80% had active and 20% had healed disease according to histopathology. A higher percentage of those with active arteritis had ischaemic optic neuropathy (ION) (36% versus 6%, p =.03), elevated erythrocyte sedimentation rates (92% versus 63%, p =.01), elevated C-reactive protein levels (79% versus 46%, p =.049), GCA risk score > 7.5% (99% sensitivity, 100% versus 71%, p <.001), higher mean GCA risk calculator scores (neural network p =.001; logistic regression p =.002). Patients with healed arteritis were less likely to have visual manifestations than the active arteritis group (38% versus 71%, p =.04). Patients with active vasculitis on biopsy had higher rates of ION and elevated inflammatory markers, as well as higher predictive scores from the GCA risk calculator. Further research is needed regarding correlation of biopsy findings and risk of complications or relapses.