Article Text

PDF
Pathological features of temporal arteries in patients with giant cell arteritis presenting with permanent visual loss
  1. D Chatelain1,
  2. P Duhaut2,
  3. J Schmidt2,
  4. R Loire3,
  5. S Bosshard3,
  6. M Guernou1,
  7. H Pellet3,
  8. J C Piette4,
  9. H Sevestre1,
  10. J P Ducroix2
  1. 1
    Department of Pathology, CHU Nord, Amiens, France
  2. 2
    Department of Internal Medicine and RECIF, CHU Nord, Amiens, France
  3. 3
    RECIF, Claude Bernard University, Lyon, France
  4. 4
    Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France
  1. D Chatelain, Department of Pathology, CHU Amiens, Place Victor Pauchet, 80054 Amiens Cedex 01, France; chatelain.denis{at}chu-amiens.fr

Abstract

Background: Permanent visual loss (PVL) is the most feared complication of giant cell arteritis (GCA), and its risk factors are still unclear.

Objectives: The aim of our study was to assess the pathological features predictive of PVL on temporal artery biopsy (TAB) specimens in patients with GCA.

Methods: The slides of 391 TAB specimens from patients with GCA were reviewed by two pathologists without clinical information.

Results: A total of 29 patients (26 females and 3 males, mean age 78.3 years) presented with unilateral PVL at the onset of the disease, and 362 patients (258 females, 104 males, mean age 74.7 years), did not. The pathological features strongly predictive for PVL were the presence (p = 0.003), number (p = 0.001) and aggregates of giant cells (p = 0.001), presence of plasmocytes (p = 0.002), thickened intima (p = 0.007), neoangiogenesis (p = 0.001) and degree of arterial occlusion (p = 0.006). Presence of neutrophils, eosinophils, parietal necrosis, calcification in the arterial wall and disruption of the internal elastic membrane were similar in both groups. Total obstruction of the arterial lumen by a thrombus, intensity of the inflammatory cells infiltration and inflammation of small vessels, nerves and veins surrounding the temporal artery were not associated with blindness. In multivariate analysis, only giant cells remained significantly associated with PVL.

Conclusion: Giant cells are strongly associated with PVL, with a significant gradient between great risk and large number of giant cells. However, PVL was neither associated with the intensity of the inflammatory infiltrate, nor with the presence of arterial thrombosis.

Statistics from Altmetric.com

Footnotes

  • Competing interests: None declared.

  • Ethics approval: Ethics approval was obtained.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.