Vasculitic changes in the temporal artery in polyarteritis nodosa

In a retrospective study of primary vasculitis in a Norwegian community hospital 6 patients were found to have polyarteritis nodosa (PAN). Five of them had taken a temporal artery biopsy and in all biopsies vasculitic changes were found, but no giant cells. Muscle biopsies from each of the patients showed the same major vasculitic changes as in the temporal artery. The histopathological findings could not exclude temporal arteritis (TA). None of the 5 polyarteritis patients who all fulfilled the ACR 1990 criteria had a case history typical for TA. Our results give the impression that vasculitic changes in the temporal artery may be a frequent finding in PAN. An atypical case history of TA with vasculitis in the temporal artery without giant cells and atypical histopathological findings should lead to the suspicion of PAN or another primary vasculitis. We also recommend a temporal artery biopsy in all cases of suspected PAN.