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March 27, 2002

Value of Ophthalmologic Examination in Diagnosing Temporal Arteritis—Reply

Author Affiliations

Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002

JAMA. 2002;287(12):1528-1529. doi:10-1001/pubs.JAMA-ISSN-0098-7484-287-12-jlt0327

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.