how useful is temple percussion for temporal arteritis?

21 Nov

QUICK PEARLS:

prevalence of TA in the general population is less than 1%

American College of Rheumatology classification criteria (need 3/5):

  • temporal artery tenderness or decreased temporal artery pulse
  • new headache,
  • onset at > 50 years old
  • erythrocyte sedimentation rate > 50 in first hr
  • positive temporal artery biopsy.

 

 

analysis of 21 studies with temporal artery biopsies

  • 2 historical features that substantially increased the likelihood of TA among patients referred for biopsy
    • jaw claudication (positive LR, 4.2; 95% CI, 2.8-6.2)
    • diplopia (positive LR, 3.4; 95% CI, 1.3-8.6).
  • absence of any temporal artery abnormality was the only clinical factor that modestly reduced the likelihood of disease (negative LR, 0.53; 95% CI, 0.38-0.75).
  • Predictive physical findings included
    • temporal artery beading (positive LR, 4.6; 95% CI, 1.1-18.4),
    • prominence (positive LR, 4.3; 95% CI, 2.1-8.9),
    • tenderness (positive LR, 2.6; 95% CI, 1.9-3.7).

 

retrospective chart review of 98 incident cases of GCA (giant cell arteritis)

  • of the 25 (out of 98) with a clinically abnormal temporal artery (e.g. tenderness)
    • 22 (88%) were biopsy-positive
    • 3 (12%) were biopsy negative
  • of the 73 (out of 98) with a clinically normal temporal artery
    • 46 (63%) were biopsy-positive
    • 27 (37%) were biopsy negative

 

BOTTOM LINE:

how useful is temporal artery percussion?  not that great, but it’s part of the puzzle (and the ACR criteria), so it may increase the likelihood of the diagnosis.  just don’t rely on it in isolation.

 

References: JAMA article; Thierry Zenone and Marie Puget Sensitivity of clinically abnormal temporal artery in giant cell arteritis International Journal of Rheumatic Diseases 16; picture 1, picture 2

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