Giant cell arteritis (cranial arteritis, polymyalgia rheumatica)

Coronary ischaemia and occlusion in giant cell (temporal) arteritis

Reports of coronary artery involvement in giant cell (temporal) arteritis--polymyalgia rheumatica (GC(T)A--PMR) together with other large arteries arising from the aorta have been numerous over the past 40 years, but on this the specialist cardiac literature has been virtually silent. This article summarises that evidence, and records nine additional patients from a large group of cases with both GC(T)A--PMR and ischaemic heart disease (IHD) observed since a previous report in 1960. The case histories illustrate the benefit from corticosteroids and the hazards of non-diagnosis and premature cessation of such treatment. It seems that many patients with arteritic IHD (and claudication) are not being identified before or after death. Possible reasons for this oversight by clinicians and pathologists are offered, and suggestions are made with regard to points in history-taking and important physical signs which may help to alert the clinician. There is autopsy evidence from Malmö, Sweden, that the prevalence of GC(T)A--PMR is much higher than at present suspected on clinical grounds.

Polymyalgia rheumatica and temporal arteritis

Polymyalgia rheumatica and temporal arteritis are separate but overlapping rheumatic diseases commonly seen among elderly persons. Polymyalgia rheumatica is characterized by upper body and trunk myalgias/arthralgias and an elevation in erythrocyte sedimentation rate. In about half of patients, temporal arteritis begins after polymyalgia rheumatica. Temporal arteritis is a systemic granulomatous disease that predominantly affects branches of the carotid artery. Claudication of the muscles of mastication and a painful burning tongue may develop during temporal arteritis or be the initial presenting symptoms. Recognition that these orofacial manifestations may be part of the disease process is mandatory because one third of patients with untreated temporal arteritis may go blind.

Giant cell arteritis and polymyalgia rheumatica. Review for the otolaryngologist

Patients suspected of giant cell arteritis or polymyalgia rheumatica are often referred to the otolaryngologist for temporal artery biopsy. These patients may initially present to the otolaryngologist with symptoms referable to the head and neck. A comprehensive review of these two interrelated disorders is provided, with emphasis on head and neck manifestations and features of obtaining the temporal artery biopsy specimen.

The headache of temporal arteritis

Patients with temporal arteritis may be misdiagnosed because the headache does not affect the temples. The records of 24 patients with biopsy proven temporal arteritis were reviewed to determine the site and other qualities of headache. Past reports of the sites of headache in this disease were also reviewed. The temporal area was the sole site of headache in only six of 24 patients; the temple was included in pain that affected the frontal, vertex, and occipital areas in another seven patients. Two patients had generalized headaches. The headache did not involve the temple in seven patients and two patients did not experience headaches. Temporal arteritis should be considered in every elderly individual who begins to complain of headache, no matter what the site, quality, severity, or time pattern.

Lingual infarction in giant cell arteritis. A case report

Giant cell arteritis is a disease of the elderly, affecting the temporal or other cranial arteries, often in patients with polymyalgia rheumatica. A case of giant cell arteritis with necrosis of the tongue in a 77-year-old woman is reported. It is important to be aware of this condition because of the serious complications. As the lesion is focally distributed, it is necessary to obtain a large biopsy specimen from the superficial temporal artery in order to make a correct diagnosis. Prompt treatment with corticosteroid in large doses followed by a lower maintenance dose is important to prevent vascular complications.

Giant cell arteritis presenting as interstitial lung disease

A 58-year-old woman had a clinical history compatible with polymyalgia rheumatica but with an unexplained interstitial lung disease. Evaluation, including biopsy specimens of temporal artery, lung, and gastrocnemius muscle, was consistent with giant cell arteritis. This case identifies giant cell arteritis as a cause of interstitial lung disease.

Immune complexes, rheumatoid factors, and cellular immunological parameters in patients with giant cell arteritis

Circulating immune complexes were found in 2 of 15 patients with giant cell arteritis (GCA) by using a solid phase Clq enzyme linked immunoabsorbent assay (ELISA). The prevalence in controls was 5%. Rheumatoid factor could be demonstrated in 2 out of 27 patients and in 11% of the controls by using a similar ELISA technique. The prevalence of T cells in blood was similar in 25 patients with GCA and in controls. The blood lymphocyte blastogenic response to the mitogens, phytohaemagglutinin, concanavalin-A, and pokeweed mitogen did not differ in 25 untreated patients compared with controls. Stimulation of lymphocytes by arterial homogenates was tested in 8 patients. In no case could a significant simulation by obtained. We conclude that immune complexes and rheumatoid factors are present in the same low frequency in GCA patients as in the normal population, and that the studied parameters of cellular immunity appear to be normal.

Cranial arteritis in otolaryngology

Cranial arteritis has the common presenting manifestations of headache and visual loss and is generally limited to elderly individuals. Nearly 50% of patients with the musculoskeletal disorder of polymyalgia rheumatica have an associated cranial arteritis, but the exact pathophysiologic relationship remains unclear. Although the literature suggests that otolaryngologic manifestations of cranial arteritis are infrequent, this report supports a contradictory viewpoint. Approximately 25% of patients with masticatory claudication, tongue pain, or frank lingual infarction. These oral manifestations should be recognized as indicators of a serious underlying arteritis.

Intracranial giant cell arteritis

A case of giant cell arteritis of intracranial vessels diagnosed by autopsy is described. Giant cell arteritis of the proximal basal brain arteries was exceptionally marked in a man of 60 years. The clinical course, laboratory findings and the pathological alterations of the brain and intracranial blood vessels are described. The case is discussed on the basis of the literature on giant cell arteritis with cerebral symptoms as well as on granulomatous giant cells arteritis of the brain. A separation of these two entities does not seem justified.