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Query: UMLS:C0039483 (giant cell arteritis)
 3,204 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of hemiplegia in a 46 year old woman is described. Total occlusion of the right internal carotid artery was discovered at angiography. Because of persistent elevation of the ESR, and characteristic plasma protein abnormalities, biopsy of the temporal artery was carried out and demonstrated the typical features of giant cell arteritis.
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PMID:Internal carotid artery occlusion caused by giant cell arteritis. 50 73

Seven patients of temporal arteritis with eye involvement have been presented. These cases represent a spectrum of disease from intermittent diplopia with minimal 6th nerve weakness through mild retinal ischemia with recovery to permanent bilateral blindness. Temporal arteritis should be suspected when any form of ocular ischemia is suspected by history or found on examination of an elderly person. An early diagnosis may protect the vision in both eyes if vision is normal at the time of diagnosis. If vision in one eye is decreased because of ischemia, the vision in the other eye can usually be retained if proper therapy is instituted. Furthermore, adequate therapy may even result in improvement in vision in the involved eye. Patients with biopsy proven temporal arteritis should be continued on steroid therapy until the active disease is quiescent. Inactivity should be determined by carefully monitoring the ESR while steroids are being tapered. If the ESR rises, it is indicative of continued inflammation and if steroids are not continued, the eyes remain at risk as seen in Case 5. If the ESR remains elevated for a year or more despite continuation of high steroid levels, consideration should be given to repeating the temporal artery biopsy. Temporal arteritis should be considered in the differential diagnosis of any multisystem disease in older patients. Even central nervous system involvement may occur concomitantly, since the intracranial vessels are not immune from the disease process. Tuberculosis, systemic syphilis and more recently the collagen vascular diseases have been dubbed the "great imitators" and "the protean diseases." We suggest that the same terminology can be applied to temporal arteritis. Temporal arteritis can affect any organ. Moreover, there is a wide spectrum of variation in the degree of involvement of any particular tissue as illustrated by these 7 cases of ocular involvement.
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PMID:Temporal arteritis: a spectrum of ophthalmic complications. 118 Apr 60

Out of 66 patients who were diagnosed as suffering from polymyalgia rheumatica (PMR; n = 40), temporal arteritis (AT; n = 14) or both (n = 12) in a 6.5 year period (incidence 3.4/100,000 per year), 9 died and 49 were followed up for an average period of 28 months. Exacerbations of the illness (n = 24) and complications in the course (n = 32) were more frequent with an initial ESR greater than 90 mm/h. Postural vertigo (n = 11), amaurosis fugax (n = 11) and polyneuropathy (n = 8) were the most frequent neurological complications. Persisting unilateral blindness and aromatic anosmia developed in 2 patients each. Complications were significantly more frequent in patients with initial symptoms of AT (chi 2 P less than 0.001). CRP-levels correlated better with persisting symptoms in the course than did the ESR. Recurrences after treatment were significantly more frequent when the length of corticosteroid-therapy was less than 20 months (chi 2 P less than 0.009). On follow up there were normal values for neopterin, tumour necrosis factor and antibodies against Borrelia burgdorferi.
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PMID:Clinical and laboratory findings with giant cell arteritis. 140 90

This study was designed to investigate the value of biologic evidence of inflammation for the diagnosis of giant cell arteritis. Experienced physicians were asked to evaluate five pairs of medical records based on real cases. In each pair, one case lacked biologic evidence of inflammation. This study offered the opportunity to explore the feasibility of a simplified Bayes model. A blind evaluation obtained by showing the paired case-reports with similar evidence of inflammation in both cases of each pair to 14 specialty physicians yielded a likelihood of diagnosis of +/- 20%. Analysis of the 46 responses to the study demonstrated, despite wide variations, a significantly greater likelihood of diagnosis in the cases with evidence of inflammation. Nevertheless, 17% to 36% of physicians--according to the case-report--ascribed virtually no importance to the ESR. Most of the physicians considered temporal artery biopsy was warranted when the likelihood of diagnosis was greater than 25%. Emergency corticosteroid therapy while awaiting the histologic results was approved by most responders when the likelihood of diagnosis was greater than 65%. The "pre-test" likelihood, calculated assuming that sensitivity and specificity of the ESR are 0.99 and 0.50, respectively, ranged from 0.89 to 0.98 for the case-reports with no evidence of inflammation and from 0.16 to 0.59 for the case-reports with evidence of inflammation In theory, the figures for the two types of case-report should not differ by more than 20%. Use of a low value for specificity (0.05) would improve the fit of values in cases without evidence of inflammation but would increase discrepancies in the other cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Significance of inflammatory syndrome in the diagnosis of Horton's disease. Attempt at the application of Bayesian analysis]. 141 Nov 93

The most useful investigation in supporting the clinical diagnosis of PMR/GCA is elevation of the ESR or viscosity. Acute phase proteins, particularly C-reactive protein, are also elevated but in most cases are not more helpful than the ESR in either diagnosis or follow-up. The definitive investigation is the demonstration of giant cell arteritis histologically, usually from temporal artery biopsy. The classical changes are internal elastic lamina fragmentation and destruction, with marked intimal thickening and an inflammatory infiltrate in the vessel wall with giant cells. Changes of healed arteritis can be distinguished from ageing changes and can therefore confirm the diagnosis. Positive biopsies are found in about 70% of patients with clinical GCA but are unlikely to be helpful in pure PMR. Elevation of alkaline phosphatase of liver origin is seen in one-third to half of patients with both PMR and GCA. Abnormal tracer uptake has been reported in radionuclide scans with a variety of non-specific abnormalities on liver biopsy. Promising developments include measurement of CD8+ lymphocytes and interleukins.
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PMID:Laboratory investigations including liver in polymyalgia rheumatica/giant cell arteritis. 180 22

Corticosteroids control arteritis in GCA and suppress polymyalgic symptoms within days of starting treatment. PMR patients can be treated with approximately 15 mg prednisolone/day, reducing the dose to 7.5-10 mg by 8 weeks. GCA is normally controlled on 40 mg prednisolone/day, although patients with persistent visual symptoms may need 60-80 mg. Slow reduction to about 20 mg by 8 weeks should minimize relapses. For both PMR and GCA a maintenance dose of 7.5 mg after 6-9 months should be enough. Steroid withdrawal is possible within 2 years of starting treatment, although some will need 4 years or more. Relapse should be defined clinically; the ESR is the most useful laboratory parameter. Steroid side-effects can be minimized by using low doses of prednisolone whenever possible and azathioprine may be used as a steroid-sparing agent.
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PMID:Treatment of polymyalgia rheumatica/giant cell arteritis. 180 23

Rapidly developing mental confusion and concomitant physical deterioration are reported as presenting symptoms in a case of giant cell arteritis (GCA). Systemic glucocorticoid therapy was followed by partial remission of neuropsychiatric symptoms and complete physical recovery. GCA should be considered as a cause of treatable dementia in the elderly. Temporal artery biopsy is recommended in dement elderly persons with elevated ESR of unknown cause.
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PMID:[Reversible dementia caused by giant cell arteritis]. 194 62

An 80-year-old woman was admitted after a 4 months history of severe headache. Laboratory data revealed elevated ESR, mild anemia and alteration of liver function test. Temporal artery biopsy showed the classical picture of giant cell arteritis. The clinical symptoms and laboratory abnormalities reversed to normal after prednisolone therapy. Although the true prevalence of this disease is unknown in Thailand, previous studies in western countries have revealed that it is not a common disease. GCA may be missed or incorrectly diagnosed in elderly patients with headache and a high ESR. Such a diagnosis can subject the patient to complication of GCA, needless biopsy and serious side effects of therapy with large doses of prednisolone.
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PMID:Giant cell arteritis. 223 Jun 31

Temporal arteritis is an uncommon condition but must be recognised early if complications such as blindness are to be avoided. The onset of daily headache or systemic disturbance with muscle and joint pains in patients over the age of 50 years should arouse suspicion. The ESR is usually greater than 40 mm an hour, but it is advisable to proceed to temporal artery biopsy if the story is typical even though initially the ESR may be normal. Histological confirmation is desirable because steroid therapy may have to continue for several years.
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PMID:Temporal arteritis. A preventable cause of blindness. 227 64

Laboratory hallmarks of giant cell arteritis (GCA) are mainly an elevated ESR and a decreased level of the CD8+ T-lymphocyte subset. Because a normal or minimally raised ESR is found in 10-20% of patients with an active GCA, we assessed the role of the CD8+ T-cell subset in patients with high and low acute hepatic phase response. Fifty-five patients with active, untreated disease were studied. The median ESR was 85 mm/h and the median CRP was 57 mg/l (normal controls less than 10 mg/l). The median CD8+T-cell reading was 0.197 X 10(9)/l and the median CD8% was 10.0 (3.8 - 23), which was significantly different from normal controls (CD8+ T-cells 0.511 X 10(9)/l, CD8+% 22 (12 - 32] (p less than 0.05). A low acute phase response (median ESR 41 mm/h, range 12-47) was identified in 11 patients or 20%. In these patients the median CD8+ T-cell reading was 0.176 x 10(9)/l and the median CD8+% 8.5 (4.3 - 15). These CD8+ values were significantly lower than values for the CD8+ T-cells (0.209 x 10(9)/l) and CD8+% (10.0), found in patients with a high acute phase response (median ESR 90 mm/h, range 50 - 145) (p less than 0.01). Our study confirms the presence of a subgroup of patients with PMR/AT who, despite active disease, exhibit a low acute phase response, and further indicates that this subgroup is characterized by a marked depletion of CD8+ T-cells in peripheral blood.
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PMID:CD8+ lymphocyte subset in polymyalgia rheumatica and arteritis temporalis. Inverse relationship between the acute hepatic phase reactants and the CD8+ T-cell subset. 253 2


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