In Reply: The primary purpose of our article
was not to determine the incremental value of ophthalmologic examination in
the diagnosis of temporal arteritis, but rather to determine the diagnostic
value of the history, physical examination, and ESR among patients with suspected
temporal arteritis. We agree with Dr Blodi that an ophthalmologic examination
may be particularly useful for the subset of patients with suspected temporal
arteritis who have visual symptoms at the time of presentation (37% in our
review). If clinicians can arrange such evaluation promptly, it is reasonable
to request this consultation while awaiting the results of the ESR measurement.
However, we do not believe that clinicians should withhold empiric systemic
corticosteroid therapy or defer biopsy in patients with a high clinical probability
of temporal arteritis (as suggested by multiple typical features or the presence
of a high likelihood feature as determined by our review), in order first
to obtain the results of an ophthalmologic examination.
Smetana GW, Shmerling RH. Value of Ophthalmologic Examination in Diagnosing Temporal Arteritis—Reply. JAMA. 2002;287(12):1528-1529. doi:10-1001/pubs.JAMA-ISSN-0098-7484-287-12-jlt0327