Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0039483 (giant cell arteritis)
 3,204 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The seven-year results of all cases (84) diagnosed as polymyalgia rheumatica or giant cell arteritis are reported. The diagnosis proved to be incorrect in seven, of which six had a polyarthritis. Most cases were treated with prednisolone, starting with 20 mg daily for those with evidence of cranial arteritis, and 10 mg for those without. Fourteen patients were withdrawn from treatment (after three months to 31/2 years--mean 21 months), but three relapsed and treatment has been restarted. There was no correlation between the presence or absence of arteritis, the starting dose of prednisolone and the subsequent duration of treatment. A small group (7) received higher doses without obvious advantage. Twenty-two started on 5-9 mg daily, but the dose had to be increased in 13 because of inadequate control of symptoms. Objective physical abnormality, particularly painful limitation of shoulder movement, was present in most cases. No patient developed a serious complication of the disease after treatment had been started. Complications of treatment were infrequent. Spinal osteoporosis occurred in seven, but did not cause long-term disability.
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PMID:Polymyalgia rheumatica and giant cell arteritis: a seven-year survey. 119 14

Although corticosteroid treatment is clearly beneficial to patients with temporal arteritis, its exact risk/benefit ratio in these old and side effects-prone patients is unknown. We have thus surveyed that available French and English literature, in order to pool the published series and to evaluate the iatrogenic potential of corticosteroids in this situation. We selected 11 series, yielding a total of 1008 patients. A treatment failure resulted in the death of the patient in five cases. Twenty-seven patients became blind, but only 2 under treatment. The side-effects involved 29% of the patients and are responsible of 29 deaths (2.9%): osteoporosis was the main problem, followed by femoral head necrosis and muscle wasting. Gastroduodenal ulcers were uncommon and generally benign; sigmoid colon diverticulitis was infrequent but dangerous; some infectious complications were noted (herpes zoster, tuberculosis, etc...); high blood pressure and diabetes were common problems. Psychiatric side-effects were rare. Thus, the unwanted effects of corticosteroids in the treatment of temporal arteritis are relatively infrequent and generally not severe, except osteoporosis. They should be systematically prevented by appropriate diet and treatments (e.g., calcium, potassium, and vitamin D supplements).
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PMID:[Benefits of corticosteroids in the treatment of Horton's disease and rhizomelic pseudopolyarthritis: advantages and inconveniences. A meta-analysis]. 134 39

Due to good therapeutic results and few side-effects so-called "low-dose glucocorticoid therapy" (ldgc) with daily glucosteroid dosage below 10 mg prednisolone-equivalent has recently been recommended in managing polymyalgia rheumatica and giant cell arteritis. This fact is of important interest, since mean therapy time is often over a period of five years. An open-prospective study with 75 patients in a rheumatological unit was done in which different clinical histories were examined and glucosteroid side effects of 47 patients who had received therapy over six months were analyzed. Main side-effect shown was osteoporosis (n = 7), other known steroid-side effects were quite seldom (less than 5%). Dosage regimens and therapy monitoring criteria are proposed.
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PMID:[Polymyalgia rheumatica and giant cell arteritis; diagnosis and side effects of low-dose long-term glucocorticoid therapy]. 147 6

Giant cell arteritis is a generalized vasculitis mainly affecting elderly people. The incidence is increasing, but only for women. The etiology is still unknown, but evidence suggests a cellular immunologic reaction against a local antigen present in the arterial wall. The disease can present itself with a great variety of symptoms. Constitutional symptoms such as fever, weight loss, and anorexia seem to be more common than hitherto believed. Onset of large artery involvement is independent of the evolution of the classic clinical symptoms. Peripheral synovitis is rarely seen in patients with polymyalgia rheumatica, and when it occurs, it is transient, nonerosive, and nondeforming. Glucocorticosteroids are the only generally accepted treatment in giant cell arteritis. After a higher initial dose of corticosteroids, most patients can be treated with a low maintenance dose, with little risk of steroid-induced osteoporosis. The erythrocyte sedimentation rate is still the best test for monitoring the disease.
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PMID:Giant cell and Takayasu's arteritis. 167 13

The analysed clinico-biological manifestations, evolutive course and treatment of 30 patients with GCA are presented. The most frequent symptoms were fever and headache. 33% of patients had FOD criteria. 26% had various visual alterations. All patients were initially treated with steroids. Of the 26 patients followed up, 21 (81.7%) experienced some sort of complication: Cushing iatrogenic, osteoporosis, vertebrae collapse, aseptic necrosis of the femur head, arterial hypertension, diabetes mellitus, hyperlipidemia, steroid myopathy. 6 patients were treated with cyclophosphamide, following severe complications secondary to steroid therapy, and all of them had a good clinical evolution.
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PMID:[Giant-cell arteritis: the clinico-biological manifestations and the complications secondary to steroid treatment]. 191 67

The mineral content of the heel bone, and signs of osteoporosis on X-ray of the spine, were evaluated in 26 patients (20 women and 6 men) with giant cell arteritis (GCA), treated with prednisolone for an average period of 5 years. The mean age was 78 years (range 66-95 years). These results were compared with those obtained from a large population study of individuals aged 72, 75, 82 and 85 years. An increase of obvious and severe spinal osteoporosis from 16 to 85% was observed in the women in the population study between the ages of 72 and 85. No additional osteoporosis that could be attributed to the cortisone treatment was found among the GCA patients. The bone mineral content was not reduced in the patients compared to the general population. We conclude that there is no justification for attempting non-steroid treatment in GCA on account of the risk of osteoporosis. Corticosteroids are the only safe treatment for prevention of complications of GCA.
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PMID:Osteoporosis after long-term corticosteroid treatment of giant cell arteritis. 235 26

The basal and calcium-stimulated calcitonin response was measured in 10 patients with giant cell arteritis before and 1, 3 and 6 wk after the start of daily treatment with 60 mg of prednisone. The study shows that plasma calcitonin level in response to a calcium injection is increased after 1 wk treatment with prednisone. Later on the calcitonin secretion capacity diminishes significantly compared to the initial level. The phylogenetic old calcitonin system first tries to prevent the occurrence of the process of osteoporosis. Moreover, exhaustion of this system later contributes to the process of steroid osteoporosis.
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PMID:Change of serum calcitonin in patients receiving glucocorticoids: an acute phase study. 239 96

The coincidence of arthritis with polymyalgia rheumatica (PMR) or temporal arteritis (TA) is not well established. After reviewing the literature we found that 22% of patients suffering from PMR/TA present with additional signs of inflammatory joint involvement. Joints predominantly affected are the sternal junctions, knee and shoulder joints, and the wrists, involvement of the latter frequently resulting in carpal tunnel syndrome. With the exception of sternal junctions, bony erosions are rarely seen. In most cases, synovitis is mild, pauciarticular, asymmetrical, transient and not destructive. Little evidence for inflammatory involvement of spine or sacroiliac joints was found, thus, back pain in these patients should be considered as caused by osteoporosis of the spinal column, mostly due to prolonged corticosteroid treatment.
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PMID:[Joint involvement in polymyalgia rheumatica/temporal arteritis]. 265 37

Temporal arteritis is still often overlooked in 1982 as shown by the diagnostic delay reported in a retrospective review of 33 patients and in the series previously published in the medical literature. Clinical features to be especially kept in mind are the occasional nature of temporal signs, the pathognomonic value of jaw claudication and the existence of signs which may constitute a premonitory syndrome of blindness. The frequent rise in alkaline phosphatase levels is often misleading. In patients over 65 with an unexplained inflammatory syndrome, biopsy of both temporal arteries should be promptly performed, prior to the unpleasant and costly investigations designed to detect an occult carcinoma. Corticosteroids are still the best treatment of giant cell arteritis but the optimal initial dosage remains unknown as no data from randomized trials are available. Symptomatic relapses have been reported up to 10 years (5 years for ocular symptoms) after onset of the disease. Because of this protracted course, which makes adequate follow-up difficult to ensure, recovery rates from different series are at variance. The main side-effects of maintenance corticosteroid therapy in these elderly patients are osteoporosis, which warrants systematic countermeasures, and probably an increased rate of atheromatosis.
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PMID:[Horton's disease: retrospective study of 33 cases and review of the literature]. 630 48

The complications of long-term corticosteroid therapy were reviewed in 100 elderly patients who were treated for chronic obstructive airways disease (n = 76), rheumatoid arthritis (n = 19) and ulcerative colitis (n = 5). The incidence of side effects was high (40%) and appeared to be dose-related. Osteoporosis (16%) and hypertension (12%) were the most common. Hypokalaemia occurred infrequently despite the fact that 69 patients were also prescribed diuretics. A further group of 36 patients receiving corticosteroids for polymyalgia rheumatica and giant cell arteritis also seemed to demonstrate a dose-related effect on the incidence of complications although this could not be confirmed statistically.
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PMID:The complications of systemic corticosteroid therapy in the elderly. A retrospective study. 669 8


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