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

Polymyalgia rheumatica is a clinical syndrome of proximal muscle pain in older patients that often presents a diagnostic challenge because of the large differential diagnosis, lack of definitive diagnostic criteria, and relatively frequent "atypical" clinical findings, such as peripheral synovitis, distal extremity pain, normal erythrocyte sedimentation rate, and mild weakness. Despite an extensive differential diagnosis that includes endocarditis and steroid-responsive malignant neoplasms, routine laboratory testing should be limited, and a low-dose corticosteroid trial is useful as the final step in the evaluation. The clinical overlap with seronegative rheumatoid arthritis is striking, suggesting that these diagnoses may represent different presentations of a similar disease process. While concurrent asymptomatic temporal arteritis is common, there are no data to support obtaining a temporal artery biopsy in patients with pure polymyalgia rheumatica symptoms.
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PMID:Diagnostic dilemmas in polymyalgia rheumatica. 943 85

The autopsy findings of a 74-year-old women who unexpectedly died are presented. She had suffered from polymyalgia but typical symptoms of temporal arteritis had been absent and tentative treatment with prednisone had not improved the polymyalgic pain. The autopsy revealed a generalized giant cell arteritis involving the left temporal artery, the left common carotid artery, the ascending aorta, a submucosal artery of the ileum and the left anterior descending branch of the coronary arteries. Histology showed typical granulomatous infiltrates including giant cells, followed by thrombotical occlusion of the coronary artery branch and subsequent myocardial infarction. Giant cell arteritis is a systemic vasculitis of aged subjects with predominant localisation in the cranial arteries, but occasional involvement of any type of visceral and peripheral arteries. Coronary involvement with sudden cardiac death is not a commen complication of giant cell arteritis but has occasionally been described in the literature.
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PMID:[Sudden cardiac death in giant cell arteritis]. 903 14

True rheumatologic emergencies are rare but they do occur. In many cases, the initial assessment, diagnosis, and treatment will rest in the hands of the primary care physician. Most common is acute onset of inflammatory arthritis. Properly diagnosed, adequate to dramatic improvements are usual with appropriate treatment. No less pressing are the neurologic emergencies such as spinal stenosis, cauda equina syndrome, and GCA. Among these, the potential for neurologic complications is high, so prompt diagnosis and treatment are essential. Cervical spine involvement in RA is common; again, neurologic complications are possible. The role of mechanical stabilization via surgery is not as well delineated but should be considered in patients with intractable pain due to C1-C2 facet joint disease and those with progressive neurologic deficiencies.
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PMID:Rheumatologic emergencies. 904 22

Radionuclide bone scintigraphy is a sensitive but not a specific technique for the diagnosis of bone metastases. Three patients, a man of 67 on steroid therapy because of chronic obstructive pulmonary disease and prostate cancer, a woman of 76 on steroid therapy because of temporal arteritis and a 50-year-old man with pain in the back, had bone scintigrams showing abnormal uptake (hot spots). There were delays of months before the diagnosis of osteoporosis instead of bone metastases was made. Abnormal uptake on a bone scintigram is often non-specific and requires further evaluation using supplementary diagnostic techniques.
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PMID:[Hot spots: metastases or osteoporosis?]. 934 May 50

Establishing an open and honest physician-patient relationship is essential for the proper evaluation and management of headache disorders. Obtaining a complete headache and medical history is the most important part of the initial diagnostic evaluation. This history should include information about headache onset, pain intensity, character of the pain, presence of aura, associated autonomic symptoms, and trigger factors. Special attention must be paid to the frequency of analgesic use, both prescription and over-the-counter, to identify analgesic rebound headache. A thorough neurologic examination must also be performed; if it is normal, there is usually no need for special tests. Headaches are classified as either primary or secondary. Primary headaches have no structural or metabolic cause, while secondary headaches are caused by an underlying pathologic or metabolic process. Migraine, tension-type, cluster, and analgesic-rebound headaches are all primary headache disorders. Secondary headaches are caused by conditions such as increased intracranial pressure, pseudotumor cerebri, subdural and intracerebral hematomas, hypertension, meningitis, temporal arteritis, Lyme disease, and brain tumors. Accurate diagnosis of headache is essential to determine the appropriateness of further testing and to guide proper treatment of the patient's condition.
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PMID:Practical evaluation and diagnosis of headache. 947 10

Giant cell arteritis is a systemic disease of unknown origin characterized by vasculitis of medium-sized and larger vessels, found mainly in elderly women. It presents with a variety of symptoms, including temporal pain and tenderness, headache, and neuroophthalmic features. This report describes a case of giant cell arteritis in a 78-year-old woman with a large ulceration on the right side of the tongue, painful lesion in the right temporal area, and recent visus loss of the right eye.
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PMID:Oral manifestations of giant cell arteritis. 948 33

Giant cell (temporal) arteritis is a systemic vasculitis involving medium and large-sized vessels. Despite the high frequency of involvement of cranial arteries, pain on examination of the external carotid artery itself has been exceptionally reported. We describe 3 patients with biopsy-proven giant cell arteritis (GCA) and wincing pain on palpation over the external carotid. The presence of this sign may be a harbinger of the existence of severe vascular involvement in patients with GCA.
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PMID:Carotid tenderness: an ominous sign of giant cell arteritis? 957 45

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

Polymyalgia rheumatica is a clinically defined disorder characterised by inflammatory pain in the neck, back, or shoulder or pelvic girdle muscles in a patient over 50 years of age. Results of laboratory work-up reflect only the inflammatory syndrome. Early diagnosis allows rapid initiation of low-dose corticosteroids, which dramatically improves the symptoms and avoids long, costly and difficult investigations. The cause of the disorder is poorly understood and its relationship to temporal arteritis is sometimes unclear, although the two can usually be distinguished, based on recent findings.
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PMID:[Diagnosis and treatment of polymyalgia rheumatica]. 1021 94

Arteritis of giant cells compromising extracranial and particularly intestinal tissues is not frequent. Therefore, it is common practice to make the diagnosis retrospectively after analyzing the surgical sample. A case is presented of an 83 year old woman admitted to the Clinical Department with a clinical course of 3 days of evolution characterized by fever and pain in the left hemiabdomen. Her personal medical history included multiple diverticulosis of colon, collecistectomy and appendicectomy. Laboratory tests showed that uremia was 0.75 g/L (N.L to 0.45 g/L), V.E.S. 90 mm at the first hour, and the rest of the determinations were normal. The chest and abdomen rays as well as the abdomen and pelvis ecographies were normal. A diagnosis was reached as acute diverticulitis and the patient was treated with 400 mgr of ciprofloxacina and 2,000 mgr a day of metronidazol. She continued in a feverish state and with abdominal pain, so that an anexial tomography of abdomen was taken. It showed a widening of peritoneal fascias with scarce liquid in the left parietocolic dripping and Douglas septum. After 96 hours, surgery exploration was done and injuries in the left colon revealed compatibility with an infarct of the colon which had to be extirpated. Pathological examination revealed an infarct of colon due to a secondary arterial thrombosis characteristic of giant cell arteritis. After the diagnosis, immunological studies and biopsy of the left temporal artery were performed and reported as normal. The patient was treated with 40 mgr of prednisone a day improving rapidly.
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PMID:[Intestinal infarct caused by giant cell arteritis]. 1034 27


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