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

Incomplete clinical response or persistence of a rapid ESR despite corticosteroid treatment of polymyalgia rheumatica or temporal arteritis should always arouse suspicion and prompt a search for other diagnoses. Lumbar spinal stenosis and Pancoast's tumor are two unusual entities that can complicate or compete for the diagnosis of polymyalgia rheumatica and temporal arteritis.
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PMID:Diagnostic errors in polymyalgia rheumatica and temporal arteritis. 729 73

Twenty-five patients with biopsy-proven giant cell arteritis (GCA) were treated at the Royal Adelaide Hospital from 1973 to 1978. Three patients had a normal ESR on presentation. Four patients developed monocular blindness, one had gangrene of the tongue, and one had a brain-stem stroke. Six patients had concurrent autoimmune thyroid disease, one suffered from myasthenia gravis and one had ulcerative colitis--a significant observation in view of the suggestion that GCA has an immunological basis.
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PMID:Giant cell arteritis. A five-year review of biopsy-proven cases in a teaching hospital. 739 75

A retrospective study was made of 96 patients diagnosed as cranial arteritis of whom 32 were accepted using strict clinical criteria or a positive temporal artery biopsy. Unusual presentations of fever, psychiatric illness, headache-free patients and a 'normal' ESR are described. The recognition of these variations is important in the early diagnosis of temporal arteritis.
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PMID:Unusual variants in the presentation of temporal arteritis. 739 2

A review of the medical records between 1971 and 1977 from four Emory University affiliated hospitals revealed 12 white patients and one black patient who had biopsy-proven temporal arteritis. Anemia and an elevated alkaline phosphatase level were noted in eight of the 13 patients, and the ESR was elevated in all thirteen. Symptoms resolved rapidly with corticosteroid therapy. No differences were noted in presentation, response to therapy, or complications between the two racial groups studied here and those reviewed in the literature.
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PMID:Temporal arteritis in a black patient. 739 29

The case reported here illustrates some of the protean manifestations of temporal arteritis. Perhaps, as more cases with atypical manifestations are described, physicians will become more alert to the possibility of this diagnosis. It is now our policy to include temporal arteritis high on the list of differential diagnoses for any neuropsychiatric, visual, or systemic complaint in an elderly patient, even in the absence of typical manifestations. A temporal artery biopsy done relatively early in undiagnosed illness may reveal a very treatable cause. We wish to emphasize the need for early consideration of temporal arteritis in the elderly patient with an elevated ESR and any unexplained neuropsychiatric problem.
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PMID:Temporal arteritis presenting as ataxia and dementia. 745 49

The original descriptions of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in the medical literature date back to 1888 and 1890, respectively. Classification criteria for PMR and GCA are not standardized since most authors used subjective criteria based on their personal experience. Only one study has evaluated criteria for PMR and has found seven variables with high discriminant value. Criteria for GCA are less varied because a positive biopsy of the temporal artery is diagnostic. However, combinations of different clinical and laboratory features have been used for diagnosis when biopsy is negative or missing. Assessment of PMR/GCA is based on the serial determination of markers of acute phase such as ESR, CRP, or plasma viscosity. However, their value in predicting recurrence of the diseases is poor. New immunological factors including soluble interleukin-2 receptors, interleukin-6, serum soluble CD8, and serum soluble intercellular adhesion molecule-1 are presently under investigation.
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PMID:Polymyalgia rheumatica and giant cell arteritis. 749 36

Manifestations of polymyalgia rheumatica in 100 ambulatory patients of an internistic, rheumatological specialist's practice were investigated. In this group of patients, both the clinical course of the disease and its prognosis were found to be more benign than is commonly reported in the literature. Thus, for example, temporal arteritis was found in only three of the one hundred patients. Not all of the patients were found to have the markedly elevated ESR normally considered to be typical. For this reason, to establish inflammatory activity, in addition to ESR, C-reactive protein (CRP) should also be determined in order to ensure that atypical forms with less marked signs of inflammation are not overlooked. Thirty of the 100 patients reported possible triggering life events.
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PMID:[Polymyalgia rheumatica in patients of a rheumatologic specialty practice. Clinical signs and etiological events]. 778 31

Forty-four patients with polymyalgia rheumatica and/or giant cell arteritis (PMR/GCA) were followed from presentation, through remissions and relapses for a median duration of 36 months. Clinical disease activity, ESR, CRP and alpha 1-antichymotrypsin (alpha 1-ACT) were measured. Before treatment ESR, CRP and alpha 1-ACT were all significantly raised, compared with age- and sex-matched controls. On clinical remission with prednisolone treatment, ESR and CRP fell to control levels but alpha 1-ACT behaved quite differently, remaining raised for 18 months or until prednisolone treatment could be withdrawn. At 18 month follow-up of PMR/GCA, and alpha 1-ACT level of < or = 0.7 g/l was associated with a reduced risk of subsequent relapse (P = 0.006). At clinical relapse during treatment, ESR was not raised compared with controls, and CRP, although significantly higher than controls (P = 0.015), remained less than 6 mg/l in the majority of patients. The three laboratory investigations were, therefore, of limited value in confirming relapses of PMR/GCA during prednisolone treatment, but alpha 1-ACT may be useful as an indicator of underlying disease activity and hence as a guide to the speed that the prednisolone dosage should be reduced.
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PMID:Alpha 1-antichymotrypsin, C-reactive protein and erythrocyte sedimentation rate in polymyalgia rheumatica and giant cell arteritis. 820 3

We report the case of a 62-year old woman hospitalized for acute ischaemia of the right lower limb, caused by stenosis of the superficial femoral artery associated with thrombosis of the deep femoral artery. Thromboendarterectomy was performed, and histology of the operative specimen showed thickening of the media with clusters of giant cells and fragmentation of the internal elastic lamina, without atheroma. The diagnostic of giant cell arteritis was then considered and confirmed by the presence of headaches, 38 degrees C fever and inflammatory syndrome with ESR at 75 mm in the first hour. On the other hand, biopsy of a temporal artery was negative. Corticosteroid therapy was prescribed and gave excellent clinical, laboratory and arteriographic results. It has now been demonstrated that the arteries of the lower limbs may be involved in Horton's giant cell arteritis, which is often overlooked. This involvement is rare and exceptionally proven at histology. Clinically, the most frequently described form is one of pseudo-arteritis with claudication, but a few cases of gangrene have been reported. Withdrawal of corticosteroid might be a facilitating factor. As in our patient, the arteriographic lesions are often segmental, multifocal and symmetrical, predominant in the superficial femoral artery and the arteries of the legs. The lesions regress under corticosteroid therapy, and surgery can usually be avoided. Anticoagulants are commonly prescribed when the large vessels are involved. When surgery is not indicated the diagnosis can be confirmed by biopsy of the temporal artery, which is positive in the majority of cases.
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PMID:[Horton's disease disclosed by involvement of the lower limbs]. 823 46

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are common diseases in the elderly. The arteritis usually affects medium sized vessels, but large vessel involvement can also occur leading to arm claudication, bruits, loss of pulses and pallor of the upper extremities. The differential diagnosis of large vessel arteritis includes atherosclerosis and Takayasu's disease. Atherosclerosis, which affects patients of similar age to GCA is usually confined to the lower limbs and can be differentiated on the basis of the clinical setting and investigations such as the ESR, arteriography and temporal artery biopsy. Takayasu's arteritis' although histologically and arteriographically indistinguishable from GCA, is predominantly a disease of young women. A patient is described who presented with upper limb ischemia. A clinical examination revealed absence of right radial pulses and presence of murmurs at level of the carotids. The blood pressure was unrecordable in the upper right limb. The ESR was 102 mm/hr and the C-reactive protein was 11.66 mg/dl. A selective arteriography of the aortic arch and its branches revealed a right subclavian artery obstruction with good collateral circulation and a left subclavian artery stenosis. The biopsy of left temporal artery showed a typical GCA in acute stage. Treatment with prednisolone 30 mg/day was started and four weeks later, the ESR had fallen to normal. In addition this case confirms that PMR implies a systemic arteritis.
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PMID:[Giant cell arteritis and polymyalgia rheumatica presenting as subclavian artery obstruction]. 823 15


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