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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 ESR is a commonly performed laboratory test with intriguing antecedents extending back to the classical period of Western medicine. Although this background was appreciated by the physicians who popularized the test in the early part of this century, it has been largely forgotten. There has always been a lack of consensus about the role of the ESR as a nonspecific indicator of inflammation and tissue injury. The usefulness of the sedimentation rate has decreased as new methods of evaluating disease have been developed. It remains helpful in monitoring certain inflammatory processes, particularly rheumatoid arthritis, and it is of great value in the diagnosis of temporal arteritis and polymyalgia rheumatica. The use of the ESR as a screening test to identify patients who have significant disease is not supported by the literature. The basic factors influencing the sedimentation rate were understood by the early decades of this century and the most satisfactory method of performing the test was introduced by Westergren in 1921. The complex nature of the factors influencing test outcome have precluded development of a reference method or of an easily implemented quality control program. Current interest in the methodology of the ESR focuses on the development of automated closed systems that allow determination of the sedimentation rate in the collection tube. These methods offer advantages of speed, safety, and uniform specimen handling. Systems utilizing sedimentation columns less than 200 mm in length may be less sensitive to changes at higher ESRs than the Westergren method. Laboratories should consider using a closed or a closed and automated system as their routine method for performing the ESR.
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PMID:The mystique of the erythrocyte sedimentation rate. A reappraisal of one of the oldest laboratory tests still in use. 831 81

Indications for Temporal Artery Biopsy are often discussed in the diagnosis of temporal arteritis. In this retrospective study we have reviewed the clinical records of 150 patients who underwent temporal artery biopsy between 1983 and 1990 in Kantonsspital Aarau/Switzerland. In 18.6% biopsies were histologically classified as temporal arteritis. To judge the indication for temporal artery biopsy the combination of symptoms leading to biopsy and the histologic results were compared. Symptoms were divided in unspecific, such as fever, loss of weight or malaise, and more specific symptoms as headache, jaw claudication, loss of visual acuity and diplopia, tenderness of temporal artery, or polymyalgia rheumatica. In conclusion the result of this study is that temporal artery biopsy may be an important help in the diagnosis of temporal arteritis in cases with one or two specific symptoms, at which polymyalgia rheumatica is a questionable indication. In our opinion temporal artery biopsy is not indicated in cases with isolated elevation of ESR, one or more unspecific symptoms and three or more specific symptoms, because there no diagnostic profit can be suspected.
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PMID:[Indications for biopsy of the temporal artery]. 837 95

Horton giant cell arteritis can present with an atypical clinical picture that often resembles other diseases. In the case described below, the patient initially demonstrated clinical and laboratory evidence of a Candida albicans sepsis, and therefore we started antimycotic treatment with amphotericin B. Because of an adverse reaction to that drug, we added parenteral steroids before every administration of the antimycotic which led to an unexpected improvement of symptoms. This result caused us to reconsider some clinical aspects that could have been interpreted also as vasculitis, in particular for a giant cell arteritis: throbbing temporal headache, diffuse weakness, important rise in ESR, myoarthralgias. We performed a biopsy of the temporal artery that confirmed our diagnosis.
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PMID:[An atypical presentation of a case of Horton's giant-cell arteritis]. 868 82

Giant cell arteritis should not be a diagnosis of exclusion, an afterthought, or a last thought. There is urgency to establishing this diagnosis and initiating therapy. All practitioners who treat adults will be confronted with these patients. Some will have classic presentations, some will have subtle presentations. When patients complain of fever, fatigue, malaise, weight loss, or painless vision loss, GCA should be suspected. An ESR will aid in the diagnosis (although a normal ESR does not rule it out), and sometimes temporal artery biopsy will provide certainty. Giant cell arteritis is usually easy to recognize, easy to treat, and satisfying to manage.
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PMID:Giant cell arteritis: diagnosis and management. 876 98

A prospective study of 287 patients with giant cell arteritis (GCA), including polymyalgia rheumatica (PMR) and temporal arteritis (TA), was conducted during 1987-1994. All patients were evaluated prior to the start of drug treatment. During the same period, 31 patients with GCA, of whom 12 cases had TA, were admitted to other departments in the hospital. At onset of disease, all patients were > or = 50 yr of age. Peripheral arthritis was found in 24.4% of patients with PMR, while none of the patients with TA exhibited such manifestations. Clinical features at onset of disease differed from those appearing at presentation to the hospital. Thus, the gradual development of a full-blown clinical picture may be responsible for the delay in diagnosis of GCA. The majority of cases (80%) presented with "pure' PMR without clinical signs or symptoms of concomitant TA. In a random sample of 68 patients with "pure' PMR, histological examinations of biopsy specimens of the temporal artery revealed inflammatory changes in three patients only (4.4%). Consequently, arterial biopsy in patients with clinical features of PMR only, appears to be unnecessary. Among patients with TA referred to the department of internal medicine, general malaise, loss of weight and sustained fever were prominent manifestations. Such features may thus necessitate a diagnostic arterial biopsy even in the absence of clinical arteritis or myalgia. Both ESR and CRP were within normal levels in 1.2% of the cases. Further clinical and laboratory examinations performed at diagnosis of GCA disclosed only one case of malignancy. Routine chest X-rays did not reveal unexpected pathological findings. Permanent and complete blindness due to arteritis was observed in one patient only. No association between GCA and thyroid dysfunction was detected.
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PMID:A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis. 894 7

Horton temporal arteritis, or gigantocellular arteritis, is a panarteritis involving the mid-size and large arteries, in particular the temporal surface artery. This pathology is normally found in the elderly, particularly females. It can be manifest with some typical symptoms (i.e. cephalea, fever, visual disorders even leading to blindness mandibular claudication, high ESR, moderate anemia), there may be aspecific, atypical signs (i.e. only cephalea and fever, or widespread myalgia and artralgia) or it may arise following a cerebro-vascular accident. Treatment of this form of arteritis is based on the use of high doses of corticosteroids over a long period of time (at least 1-2 years). The present work describes a surgical technique for biopsying the temporal artery. The technique consists of withdrawal of a segment of the artery from the main branch and the frontal branch of the temporal surface artery. Since this form of arteritis often presents segmentary lesions, it is advisable to take a 4-5 cm sample so as to prevent false negatives. This simple surgical procedure can be performed under local anesthesia and is practically complication-free. The authors then discuss the indications for temporal artery biopsy and report 3 clinical cases (case no. 1 is an example of the classical manifestation while cases no. 2 and 3 are atypical, aspecific forms). Since both the classical and atypical forms of gigantocellular arteritis require high doses of corticosteriods over a long period of time, the temporal artery biopsy procedure is highly useful in formulating an accurate diagnosis. The well known side effects to long-term cortisone use make it necessary to use all the available instruments in making the correct diagnosis. Bilateral biopsy can be performed in those cases where the first biopsy proved negative but gigantocellular arteritis is still suspected.
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PMID:[Biopsy of the temporal artery]. 954 25

ESR is a time-honored, simple, inexpensive test, but unfortunately it lacks sensitivity and specificity. Clinicians need to be aware of appropriate uses, because any test is expensive when ordered often, and evaluation of false-positive results may incur substantial costs and place the patient at risk from additional procedures. ESR should not be used to screen asymptomatic persons for disease. If an increased ESR is encountered and no explanation is immediately apparent, clinicians should repeat the test in several months rather than pursue an exhaustive search for occult disease. ESR may be useful in establishing a "sickness index" in elderly persons who have nonspecific changes in health status and a moderate probability of underlying disease; in screening for infection in specific settings (e.g., orthopedic surgery, pediatrics, gynecology); in diagnosing and monitoring temporal arteritis, polymyalgia rheumatica, and possibly other rheumatic diseases; in monitoring patients with treated Hodgkin's disease; and in assessing iron deficiency in anemia of chronic disease (when correlated with serum ferritin level). An ESR value exceeding 100 mm/hr has a 90% predictive value for serious underlying disease, most often infection, collagen vascular disease, or metastatic tumor. In asymptomatic persons with a markedly elevated ESR value, a minimal number of tests usually reveal the cause.
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PMID:The erythrocyte sedimentation rate. Still a helpful test when used judiciously. 959 Sep 99

Giant cell arteritis (GCA) is a polysymptomatic disease which constitutes an ophthalmic emergency because early recognition and management can prevent blindness. There is conflicting information in the literature on the validity, sensitivity, and specificity of various systemic symptoms and signs of GCA. This paper presents a review of our prospective studies on the subject, and our findings are particularly relevant to dentists. We investigated 363 patients in a prospective study. Positive temporal artery biopsy was seen in 106 patients and negative in 257 referred for diagnosis of GCA. Systemic symptoms and signs of GCA and erythrocyte sedimentation rate (Westergren-ESR) and C-reactive protein (CRP) levels were compared in these two groups of patients. The odds of having a positive temporal artery biopsy (i.e., GCA) were 9.1 times greater with jaw claudication (pain in masticatory muscles on eating), 3.4 times with neck pain, 3.2 times with CRP > 2.45 mg/dL, 2.0 times with ESR 47.107 mm/hr, 2.7 times with ESR > 107 mm/hr, and 2.0 times when the patients were aged > or = 75 years. Other signs and symptoms did not show a significant association with a positive biopsy. Our study showed that "normal" ESR values do not rule out GCA but that CRP is a more useful test than ESR. Since jaw claudication is one of the most important symptoms of GCA, dentists should keep this possibility in mind when older patients come complaining of jaw pain while eating.
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PMID:Masticatory muscle pain: an important indicator of giant cell arteritis. 968 Sep 12

PMR and GCA are related conditions that seem to represent a continuum of disease. These conditions are relatively common and seem to be mediated by a cellular inflammatory response. Increasing evidence suggests an infectious cause (or causes) precipitating this immune response in genetically susceptible individuals. Whereas previously thought to affect primarily branch vessels of the aortic arch, GCA is now thought of as a disease in which proximal aortic involvement is frequent. Despite the potential for serious, even fatal complications, overall prognosis for patients with GCA or PMR is excellent. Corticosteroids remain the standard treatment, although not curative. Whereas the ESR is a useful indicator of disease activity, other markers which may be more precise such as creative protein and Il-6 seem to offer added information about disease activity.
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PMID:Polymyalgia rheumatica and giant cell arteritis. 1098 9

Cytokines are small proteins that serve as chemical messengers between cells, regulating cell growth and differentiation, tissue repair and remodeling, and many aspects of the immune response. Cytokines are instrumental in determining the nature, magnitude, and duration of inflammatory reactions and, as such, represent ideal targets for interfering with pathogenic processes. In OCA and PMR, cytokines are encountered in two locations, the inflammatory infiltrates accumulating in the arterial wall and in the circulation. IL-6, a cytokine involved in stimulating acute-phase responses, is located upstream of many of the laboratory abnormalities considered helpful in diagnosing and managing GCA/PMR, including elevated ESR and CRP. IL-6 has the potential to be helpful in predicting disease severity and may allow for a tailoring of immunosuppressive therapy. There is evidence suggesting that IL-6 outperforms other chemical markers in detecting disease activity and could, therefore, have a role in monitoring treatment. Interesting pathogenic clues have been derived from studies of cytokines produced in the vascular lesions. IFN-gamma has emerged as a key regulator in determining the nature and direction of the inflammatory response. IFN-gamma appears to be critically involved in modulating the process of intimal hyperplasia, the most destructive consequence of vasculitis, and, as such, emerges as a prime target for novel therapeutic approaches.
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PMID:Cytokines in giant-cell arteritis. 1208 74


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