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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 epidemiology, relationship to giant cell arteritis (GCA), pathogenesis, pathology, clinical and laboratory features, differential diagnosis, and treatment of polymyalgia rheumatica (PMR) are reviewed. Patients with PMR are usually over 50 years of age, white, and female. There is an association between GCA and PMR that has important implications because of the risk of blindness and other severe vascular complications in patients with GCA. The causes of PMR and GCA are unknown, although the immune system is implicated in the pathogenesis of these diseases. PMR is characterized by muscle pain and stiffness in the shoulders and hips. The principal laboratory finding is an elevated erythrocyte sedimentation rate. The differential diagnosis of PMR includes a number of diseases that cause symmetrical arthritis. It may be particularly difficult to distinguish between PMR and GCA because patients with GCA usually have symptoms associated with PMR. Nonsteroidal anti-inflammatory agents may be effective in mild cases of PMR. However, corticosteroids, usually prednisone or prednisolone, are the class of drugs most widely used to treat PMR. They are effective in relieving the pain and reversing the abnormal laboratory values in most patients; responses can be apparent in 24-48 hours. Steroid-sparing agents such as methotrexate, dapsone, and azathioprine have no established role at present. Patients taking corticosteroids for PMR should be monitored for the occurrence of GCA and development of adverse effects associated with drug therapy. Corticosteroids are effective in treating PMR. Although patients with PMR must be monitored for the development of GCA, the prognosis for these patients is excellent.
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PMID:Polymyalgia rheumatica. 822 21

Temporal arteritis is an insidious disease which, if not recognized and treated with high-dosage oral prednisone or intravenous prednisolone, can result in unilateral or even total blindness due to anterior ischemic optic neuropathy (AION) or closure of the central artery of the retina. Unfortunately, the symptoms and clinical signs of temporal arteritis mimic those of a number of other conditions including angle-closure glaucoma, hypertension, migraine, trigeminal neuralgia, temporomandibular joint syndrome, carotid artery occlusive disease, Foster-Kennedy syndrome, and nonarteritic AION. When a patient complains of a severe pain in the temporal region, along with scalp tenderness and a feeling of malaise or depression--with or without episodes of transient loss of vision--he or she should be referred for a diagnostic work-up which includes an erythrocyte sedimentation rate and a temporal artery biopsy. We present here a review of the recent literature concerning temporal arteritis, followed by a report of an unusual case in which high-dosage prednisone therapy was effective in relieving the patient's symptoms and lowering the sedimentation rate in spite of a negative temporal artery biopsy.
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PMID:Diagnosis and management of temporal arteritis: a review and case report. 823 73

Temporal arteritis is a systemic disease affecting large and medium-sized arteries in the elderly. The incidence of the disease increases with age and its major complications are blindness, cerebrovascular accidents and aortic dissection. Diagnosis is mainly based on clinical signs and symptoms. Temporal artery biopsy is a popular and simple diagnostic procedure and if positive confirms the diagnosis. However, a negative biopsy cannot exclude temporal arteritis due to its segmental nature, and the specific signs and symptoms still require treatment with corticosteroids. During the years 1982-1991 we performed 206 temporal artery biopsies, of which only 21 (10.2%) confirmed the presence of temporal arteritis. Our experience is presented with regard to the usefulness of temporal artery biopsy in particular. In view of the low biopsy yield we recommend more selective referral for this purpose.
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PMID:[Temporal artery biopsy--required or superfluous?]. 849 32

The authors have presented a case of bilateral temporal arteritis (giant cell arteritis) of a female patient taken to a hospital because of a sudden blindness of her left eye. At first, the retinal embolism has been diagnosed, but after a sudden worsening of the general condition of the patient and the diagnosis of the retinal embolism of the other eye and results of biochemical investigation tests the previous diagnosis has been changed to: bilateral temporal arteritis.
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PMID:[A case of bilateral temporal arteritis]. 875 85

Original reports on temporal arteritis and polymyalgia rheumatica were reviewed before and after the introduction of steroid therapy to prevent blindness in temporal arteritis. In some cases, the original data were reworked. There is evidence that both diseases have become more benign. As a result, the perceived risk of blindness is presently overestimated, as is the perceived benefit of steroids in reducing this risk, and neither should be used as support for an essential difference between temporal arteritis and polymyalgia rheumatica. Indeed, no qualitative differences otherwise exist and both are best viewed as facets of a common disease spectrum with variable risk of adverse outcome. Some of the difficulties in dealing with diseases characterized by variable risk within present dichotomous classifications are discussed. It is likely that in many patients benign disease is presently undiagnosed. It is likely that certain classifications of temporal arteritis and polymyalgia rheumatica now in use lead to an overtreatment of some patients with relatively benign disease.
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PMID:Temporal arteritis and polymyalgia rheumatica: nosographic and nosologic considerations. 878 60

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

We report a series of 21 consecutive patients seen at the Ophthalmology Department of the University Hospital Zurich, Switzerland, with the arteritic form of anterior ischemic optic neuropathy (AION). 19 patients had giant cell arteritis, one had periarteritis nodosa and one had cP-arteritis. They comprised 11 men and 10 women, ranging in age between 66 and 88 years. The median age was 80. We analyzed the course of events in each case before and after involvement of the first eye, as well as the frequency and possible causes of involvement of the second eye. The diagnosis was regarded as delayed when, despite typical signs, symptoms amd laboratory abnormalities, systemic vasculitis was not considered in the differential diagnosis. Treatment was considered inadequate if, following visual loss in one eye and diagnosis of a systemic vasculitis, a dose of 1 mg/kg prednisone or less was given, and/or the initial dose was reduced by more than 50% during the first month. Of 21 patients, 10 suffered bilateral visual loss. 8 of these 10 patients became legally blind. In 13 out of 21 cases there was no delay in diagnosis and treatment was adequately given. All 11 patients with unilateral involvement, who did not suffer a substantial loss in quality of life, belong to this subgroup. In 8 cases diagnosis was either delayed or treatment was inadequate. All of these patients had bilateral ocular involvement. In one patient, visual loss in the second eye could not be avoided despite correct diagnosis and treatment (M.A., No. 1). In this patient the interval between involvement of the first and second eye was very short (3 days). One patient had a mature cataract in the first affected eye and sought medical help only after his good eye became involved (K. F., No. 15). In this report we would like to draw attention to the extremely poor visual prognosis due to frequent bilateral ocular involvement in giant cell arteritis. Corticosteroid treatment cannot restore vision in the already affected eye, but it is, in the majority of cases, highly effective in preventing visual loss in the second eye. Thus, it is crucial to begin treatment immediately, to start with a high dose (preferably 1 g methyl-prednisolone i.v.), and to continue high-dose oral treatment long enough to prevent delayed visual loss in the second eye. The most vulnerable period appears to be the first month following involvement of the first eye. Caring for patients with giant cell arteritis who have lost vision in one eye is a challenge to all involved physicians. It resembles a "high-wire act" with the threat of blindness on the one hand and the dangers of long term corticosteroid treatment on the other. An interdisciplinary approach with ongoing communication between the family physician and the ophthalmologist is required.
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PMID:[The bane of giant cell arteritis from an ophthalmological viewpoint]. 900 21

The objective was to determine associated clinical findings in patients with visual loss due to giant cell arteritis (GCA) by means of a record review of 146 patients with biopsy-proven GCA. Twenty-three (15.75%) patients had lost vision. All of these patients complained of classical GCA cranial symptoms for an average of 1.3 months, 34.8% had an apparent isolated polymyalgia rheumatica for an average of 10.8 months and 65.2% had premonitory visual symptoms before visual loss for an average of 8.5 days. A clear delay in diagnosis and treatment was present in 15 patients (65.2%) who complained of at least two classical cranial symptoms for longer than 3 weeks and/or who had presented premonitory visual symptoms for longer than 72 h before blindness. Two additional patients lost vision while receiving standard steroid therapy. In conclusion, a high proportion of patients with permanent visual loss have a delayed diagnosis and treatment. A wider recognition of the disease would potentially reduce the prevalence of irreversible visual loss among GCA patients.
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PMID:Clinical features in patients with permanent visual loss due to biopsy-proven giant cell arteritis. 913 40

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are closely related disorders found predominantly in older patients. These disorders, which are being recognized more frequently, are more common in women, in Caucasians, and in various geographic locations. Early recognition and treatment may prevent possible catastrophic consequences of GCA, such as blindness, stroke, or dissection of the aorta. Although diagnosis is fairly easy with the classic presentation, it may be missed when the patient presents with nonspecific constitutional symptoms. An increased awareness among primary care physicians will aid in the prevention of much of the morbidity and mortality related to these diseases.
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PMID:Giant cell arteritis and polymyalgia rheumatica: clues to early diagnosis. 919 89

Anterior ischemic optic neuropathy (AION), one of the most prevalent and visually crippling diseases in the middle-aged and elderly, potentially bilateral, is due to acute ischemia of the optic nerve head. For a logical understanding of its pathogenesis, underlying causes, clinical features, and management, it is essential to comprehend the basic scientific issues involved; these are discussed briefly in this paper. Clinically, AION is of two types: (1) arteritic AION (due to giant cell arteritis) and (2) nonarteritic AION (due to other causes). Arteritic AION is an ophthalmic emergency because of its potential of causing rapid, bilateral complete blindness which is almost always preventable if treated immediately with large doses of systemic corticosteroids. Clinical parameters which help to differentiate the two type of AION, and their management are discussed.
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PMID:Anterior ischemic optic neuropathy. 929 52


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