Andrew Pieri, Rob Milligan, Vaidehi Hegde and Colm Hennessy
Temporal artery biopsy (TAB) is the gold standard for diagnosing temporal arteritis; however, sensitivity is relatively poor (30‐40 per cent). The British Society of Rheumatology…
Abstract
Purpose
Temporal artery biopsy (TAB) is the gold standard for diagnosing temporal arteritis; however, sensitivity is relatively poor (30‐40 per cent). The British Society of Rheumatology (BSR) guidelines state two major factors that can improve sensitivity: TAB specimen size >10mm; and pre‐biopsy steroid treatment <7 days. Owing to the low sensitivity, TA treatment is often commenced/continued despite negative histology. The purpose of this paper is to establish the extent to which TAB results influence clinical management and determine specimen adequacy regarding BSR guidelines.
Design/methodology/approach
In total, 55 patients underwent TAB between 2009‐2011. Patients' medical notes were analysed, specifically looking at biopsy specimen size, histology results and steroid therapy duration, pre‐ and post‐biopsy.
Findings
From 55 TABs, three (6 per cent) were positive, 47 (85 per cent) were negative and five (9 per cent) were “inadequate”. Of those patients with negative results, 18 (46 per cent) received > six months steroid treatment. From 50 “adequate” specimens, 31 (62 per cent) were <10 mm and 11 (28 per cent) received > seven days steroid treatment pre‐biopsy.
Practical implications
Despite negative results, many patients went on to receive long‐term steroids. Action must be taken to reduce false and true negative biopsies. False negatives may be reduced by improving adherence to BSR guidance (increased specimen size and early biopsy after commencing steroids). To reduce total true‐negative biopsies, the authors suggest implementing the American College of Rheumatology scoring system, designed to objectify the decision to perform TAB.
Originality/value
This article addresses a common problem seen in most UK hospitals. There is little literature discussing a plausible solution to reducing negative biopsies.
Details
Keywords
Liam O’Callaghan, David M. Doyle, Diarmuid Griffin and Muiread Murphy
Nobody concerned with political economy can neglect the history of economic doctrines. Structural changes in the economy and society influence economic thinking and, conversely…
Abstract
Nobody concerned with political economy can neglect the history of economic doctrines. Structural changes in the economy and society influence economic thinking and, conversely, innovative thought structures and attitudes have almost always forced economic institutions and modes of behaviour to adjust. We learn from the history of economic doctrines how a particular theory emerged and whether, and in which environment, it could take root. We can see how a school evolves out of a common methodological perception and similar techniques of analysis, and how it has to establish itself. The interaction between unresolved problems on the one hand, and the search for better solutions or explanations on the other, leads to a change in paradigma and to the formation of new lines of reasoning. As long as the real world is subject to progress and change scientific search for explanation must out of necessity continue.