Giant cell arteritis: validity and reliability of various diagnostic criteria

Am J Ophthalmol. 1997 Mar;123(3):285-96. doi: 10.1016/s0002-9394(14)70123-0.


Purpose: To ascertain the validity, reliability, sensitivity, and specificity of various signs and symptoms of and diagnostic tests for early diagnosis of giant cell arteritis.

Methods: From 1973 to 1994, we studied 363 patients who had temporal artery biopsy for suspected giant cell arteritis. All patients underwent detailed clinical evaluation and had erythrocyte sedimentation rates determined; since 1985, 223 patients had their C-reactive protein values estimated. Erythrocyte sedimentation rate and C-reactive protein levels were also estimated in 749 and 138 control subjects, respectively. Signs and symptoms of giant cell arteritis, erythrocyte sedimentation rate, and C-reactive protein levels among patients with positive and negative biopsies were compared.

Results: Of the 363 patients, temporal artery biopsy was positive in 106 and negative in 257. The odds of a positive biopsy were 9.0 times greater with jaw claudication (P < .0001), 3.4 times greater with neck pain (P = .0085), 2.0 times greater with an erythrocyte sedimentation rate of 47 to 107 mm/hour (P = .0454), 3.2 times greater with C-reactive protein above 2.45 mg/dl (P = .0208), and 2.0 times greater for age 75 years or more (P = .0105).

Conclusions: Clinical criteria most strongly suggestive of giant cell arteritis include jaw claudication, C-reactive protein above 2.45 mg/dl, neck pain, and an erythrocyte sedimentation rate of 47 mm/hour or more, in that order. C-reactive protein was more sensitive (100%) than erythrocyte sedimentation rate (92%) for detection of giant cell arteritis; erythrocyte sedimentation rate combined with C-reactive protein gave the best specificity (97%).

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Blood Sedimentation
  • C-Reactive Protein / analysis
  • Female
  • Giant Cell Arteritis / blood
  • Giant Cell Arteritis / diagnosis*
  • Humans
  • Intermittent Claudication / diagnosis
  • Intermittent Claudication / etiology
  • Jaw Diseases / diagnosis
  • Jaw Diseases / etiology
  • Male
  • Middle Aged
  • Neck Pain / diagnosis
  • Neck Pain / etiology
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Temporal Arteries / pathology


  • C-Reactive Protein