Headache as a characteristic of biopsy-confirmed giant cell arteritis in Japanese patients and the relationship of transmural inflammation with superficial temporal artery tenderness and chordal thickening: a single-center retrospective observational study

Background: Headache is an important clinical feature of giant cell arteritis (GCA), and biopsy is important for diagnosing GCA. However, no report has examined the clinical features of pathologically confirmed GCA, including headaches, in detail. Thus, we aimed to investigate detailed characteristics of GCA, including headache, and the relationship between pathological findings and clinical symptoms. Methods: We retrospectively identified 26 patients (median age; 77.5 years, male; 38.4%) with GCA who underwent superficial temporal artery (STA) biopsy at the Japanese Red Cross Shizuoka Hospital between May 2001 and February 2022. All patients met the GCA diagnostic criteria of the American College of Rheumatology and the European League Against Rheumatism. We focused on the relationship between clinical features, such as headaches, and pathological findings. Results: Twenty-four patients had a headache that tended to be unilateral, non-pulsatile, and intermittent. Transmural inflammation (TMI), a characteristic pathological finding of GCA, was observed in 14 patients. Bivariate analysis showed a significant association between TMI and STA tenderness (p=0.046) and between TMI and STA chordal thickening (p=0.021). Conclusions: Headaches in patients with GCA were often unilateral, non-pulsatile, and intermittent. Furthermore, this study is the first to report that TMI is significantly associated with STA tenderness and ligamentous thickening. We showed that abnormal STA findings were significantly related to GCA pathological findings; thus, it is necessary to pay attention to abnormal STA findings when suspecting GCA.