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Matters arising
Treatment of resistant giant cell arteritis with etanercept
  1. W P Docken1
  1. 1Brigham and Women’s Hospital, Boston, MA 02115, USA
  1. Correspondence to:
    Dr W P Docken
    850 Boylston St, Chestnut Hill, MA 02467, USA; wdockenpartners.org

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    Tan et al recently described a case of “resistant giant cell arteritis” successfully treated with etanercept.1 Their patient, who had classical symptoms of polymyalgia rheumatica (PMR), developed headaches while receiving low dose steroids. Biopsy of a temporal artery showed no arteritis. Because giant cell arteritis (GCA) was suspected on clinical grounds, high dose steroids were instituted. Six months later, despite continued steroid treatment, a transient ischaemic attack (TIA) involving right arm weakness occurred, which was ascribed to “arteritis (sic)”. An insufficiency fracture ensued. As the erythrocyte sedimentation rate and C reactive protein were persistently raised, a diagnosis of GCA resistant to treatment was made, and etanercept was given. The acute phase reactants normalised, and the symptoms referable to PMR resolved completely.

    I am not persuaded that the patient in question had GCA.

    Firstly, the temporal artery biopsy was negative. Definitive criteria for the entity of so-called biopsy negative GCA are lacking, and, in my opinion, this concept remains a problematic one. Negative temporal artery (TA) biopsies do occur in certain subsets of GCA—for example, upwards of 50% of …

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