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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 variety of rheumatologic disorders affect the elderly. Some of these problems are seen almost exclusively in the elderly, such as temporal arteritis and pseudogout. Because of underlying chronic diseases, these patients are also at increased risk for joint infection and resultant sepsis. Evaluation of synovial fluid from the inflamed joint is important. Light microscopy evaluation with a red polarizing compensator can help diagnose crystal-mediated disease, such as gout or pseudogout. Examination of Gram stains can help diagnose infectious arthritis. Thus, appropriate processing of synovial fluid is mandatory for the diagnosis of many rheumatologic disorders that occur in the elderly. A variety of metabolic disorders are associated with pseudogout and should be searched for on laboratory evaluation. Appropriate laboratory evaluation and follow-up following the acute episode are important in the care of these patients. For example, temporal arteritis with resultant blindness is a feared disorder in the elderly. Transient blindness, headaches, jaw claudication, and an elevated Westergren sedimentation rate suggest this diagnosis. Aches and pain in the neck and shoulder area, especially in the morning, are typical of polymyalgia rheumatica. Polymyalgia rheumatica may also be a symptom of temporal arteritis.
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PMID:Acute rheumatologic disorders in the elderly. 218 87

Giant cell arteritis (GCA) is a common vasculitic disease in the elderly, with a multitude of neurologic manifestations including, but not limited to, stroke and blindness. Many uncommon manifestations are often unrecognized and proper diagnosis and treatment delayed. This review focuses on the pathophysiology and neurologic symptoms of GCA, with special emphasis on the diversity of ocular involvement.
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PMID:Neurologic manifestations of giant cell arteritis. 201

Realism is one of the characteristics of Amarnian art; some details of The Harpist represented in the tomb of Pa-Aton-Em-Heb (1350 BC, 18th Dynasty) might gives clues to a diagnosis: the eyes are closed with swollen lids, and the harpist appears to stare into space; he is round shouldered with a very wasted face, his temporal ara is heightened and hollowed by a broken line joining the extremity of the eyebrow with the corner of the eye. These details are not found elsewhere. Did the harpist's blindness result from temporal arteritis associated to polymyalgia rheumatica?
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PMID:How ancient is temporal arteritis? 221 59

It is recognized that temporal arteritis may cause blindness as one of the numerous symptoms. Three case histories are presented to illustrate this. In the discussion, the effect of rapid treatment with high-dose corticosteroids is emphasized to avoid blindness.
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PMID:[Giant cell arteritis. Can blindness be avoided?]. 221 33

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

Anterior ischaemic optic neuropathy (AION), a common, visually crippling disorder, is discussed, with particular emphasis on differentiating AION due to giant cell arteritis (arteritic AION) from that not due to it (non-arteritic AION). Giant cell arteritis is an ophthalmic emergency because of imminent danger of bilateral total blindness, which is almost always preventable if the disease is quickly identified and treated urgently and aggressively. My studies have revealed that the best means of differentiating arteritic from non-arteritic AION is a combination of information from the following: systemic and visual symptoms of giant cell arteritis, high erythrocyte sedimentation rate and C-reactive protein, early massive visual loss, chalky-white optic disc swelling, associated cilio-retinal artery occlusion, massive non-filling of the choroid on fluorescein fundus angiography and temporal artery biopsy. Management of giant cell arteritis and of arteritic AION is discussed. Current misconceptions about AION are pointed out.
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PMID:Anterior ischaemic optic neuropathy. Differentiation of arteritic from non-arteritic type and its management. 232 77

Giant cell arteritis (GCA) is a vasculitis which involves in a systemic fashion the mean and medium sized arteries. Intracranial vessels are exceptionally involved. Thus, stroke is an uncommon complication. We report a patient with typical GCA with blindness due to occlusion of the central artery of the retina, who developed an imitation and utilization behavior attributable to bilateral frontal infarction without accompanying neurological symptoms. Although histological study was not available, this case fulfilled all of Russi's criteria for GCA localized in the CNS. This lends support to the suspicion that the bilateral frontal infarction might be due to it.
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PMID:[Bilateral frontal infarct with imitation and utilization syndrome in a case of giant cell arteritis]. 236 Oct 38

The authors present three cases of AION with suspected temporal arteritis to show why a Doppler sonographic examination should be performed prior to a biopsy of the temporal artery. In Case 1, with stenosis of the internal carotid artery, the cerebral perfusion depended, entirely on collateral circulation, the nutritive vessel of which was the temporal artery. Cases 2 and 3 illustrate a proximal stenosis of the ophthalmic artery. In these two cases the temporal artery maintained the blood supply to the eye. All these findings were obtained by Doppler sonographic examinations. Biopsy of the temporal artery, which could otherwise have caused sudden death in Case 1, or blindness in Cases 2 or 3, was therefore dispensed with.
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PMID:[Why perform Doppler sonography before every biopsy of the temporal artery?]. 268 57

716 cases collected from 9 recent studies published between 1981 and 1985 served as a basis for a general review of the current treatment of temporal arteritis. Steroid therapy was instituted as first intention in 652 cases, high dose treatment was continued for between 8 days and 3 months but the majority of authors started a reduction in the dosage from the 4th or 5th week. There was no overall agreement regarding the duration of maintenance therapy nor the criteria allowing its discontinuation, and withdrawal was not possible before the 25th month on average. The ideal initial dosage, in the absence of randomized studies, remains to be defined: generally around 0.5 mg/kg/d in milder forms, the dosage may be increased to 1 mg/kg/d in the presence of complicated temporal arteritis. Besides cortico steroid therapy, other treatments are successively envisaged: synthetic anti-malarials (SAM), non steroidal anti-inflammatories (NSAI), dapsone... while these are generally used as back-up treatment, David-Chausse used SAM as first intention, combined in 17 cases with NSAI in 61 of his 66 patients, with very promising results which require confirmation in other studies. In this review the cure rate was around 25% and the relapse rate 38%; complications related to the disease occurred in 19%, while almost one patient in two--47%--developed iatrogenic complications. Blindness dominates the prognosis, and occurred in 15% of cases, most often as an inaugural event, it very rarely regressed on steroid treatment. Although death occurred in 18% of cases, the prognosis of temporal arteritis generally remains favorable, with a 5 year survival curve identical to a control population.
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PMID:[Treatment of Horton's disease]. 269 71

In 1932, Horton, Magath and Brown reported two cases of a "new form of arteritis affecting the temporal vessels ... which probably represents a new clinical syndrome". In reality, several publications, devoted to the same pathology already preceded this article. The most ancient is that of an ophthalmologist from Baghdad, Ali Ibn Isa (940 to 1010). In his memories, translated and published in english in 1936, the author states that "he undertook excision and cauterisation of arteries to treat patients who were suffering from heat and inflammation of their temporal muscles and which sometimes ended in loss of vision ...". In 1890, J. Hutchinson, an English surgeon, reported a case "... of inflammed and swollen temporal arteries ...". This article was only brought to light in 1946. In 1930, M. Schmidt, published a probable case of temporal arteritis, subsequently reported in 1947. In 1934 and 1936, Horton published new cases of temporal arteritis and defined the clinical characteristics of the disease and its histology. In 1938, Jennings made a particular contribution in reporting the first case of blindness. From this time on, cases of temporal arteritis became increasingly common in the literature. The first French case was described by J. Paviot et al. in 1934, but remained largely unrecognized until 1942. In 1936, J. Chavany was the first to describe the pillow sign, but more particularly in 1948, he prescribed the first treatment with steroids, with spectacular results. It was only in 1950 that R.M. Shick et al. published the effects of steroid therapy in temporal arteritis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The history of Horton's disease or ... 10 centuries of a fascinating adventure]. 269 72


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