Giant-cell arteritis of the female genital tract

Abstract. A 56-year-old woman with long-lasting fever of unknown origin was diagnosed as having a giant-cell arteritis of the genital tract with no evidence of temporal arteritis. Diagnosis relied on pathological examination, which showed a segmental panarteritis of ovaries, myometrium, endometrium and uterus cervix. Corticosteroid therapy led to clinical cure within a few weeks. Twenty-five cases of giant-cell arteritis of the female genital tract have been published of which only four were associated with temporal arteritis. We recommend that such a diagnosis should be considered in women presenting with long-lasting fever of unknown origin, even in the absence of temporal arteritis and the clinical evidence of genital abnormalities.     

Immuno-localisation of tumour necrosis factor and its receptors in temporal arteritis

Temporal arteritis (TA) is an acute vasculitis characterised by destruction of arterial architecture following infiltration of the arterial wall by macrophages, giant cells and lymphocytes. Using immunohistochemical techniques, tumour necrosis factor (TNF) was demonstrated in up to 60% of the cells in all areas of inflamed arteries. More cells staining for TNF were detected in the intima and media of inflamed vessels than control uninflamed arteries (P<0.003 and P<0.001, respectively). In TA, TNF was localised to giant cells and macrophages, suggesting that its predominant source is from the monocyte lineage, but, occasionally, TNF staining was found in areas infiltrated by T cells. Many endothelial cells also contained TNF, but there were no differencs between the number of endothelial cells staining in inflamed and normal blood vessels. Of the two TNF receptors, the p75 receptor was sparsely represented in the inflamed vessels in TA. By comparison, the p55 receptor was widely detected on endothelial cells and infiltrating mononuclear cells close to the internal elastic lamina (IEL). Endothelial cells from normal vessels also stained for both TNF receptors, but normal smooth muscle cells in the vessel media expressed the p55 receptor, indicating that they are capable of responding to locally secreted TNF. Localisation of TNF receptors and TNF in close proximity to the IEL suggests that TNF could be involved in the leucocyte infiltration and arterial wall destruction characteristic of TA. Received: 7 Mary 1997 / Accepted: 25 July 1997     

Ulceration and Necrosis of the Tongue Due to Giant Cell Arteritis

ABSTRACT A case is reported of giant cell arteritis in a 74-year-old woman, complicated by ulceration and necrosis of the tongue. During steroid treatment recovery was observed.     

Oral and ocular/orbital manifestations of temporal arteritis: a disease with deceptive clinical symptoms and devastating consequences

Temporal arteritis (TA) is a chronic, systemic vasculitis most often presenting with severe headaches localized in the temporal region, low-grade fever, anorexia, weight loss and generalized malaise. Besides these typical characteristics, a number of vague and non-specific oral and/or ocular symptoms may also be present. A search using Medline (1955–2006) was performed for unusual oral and ocular/orbital presentations of TA. A variety of oral and ocular/orbital manifestations associated with TA have been reported. These can mislead physicians, causing a delay in establishing a diagnosis and initiating treatment. Increased awareness is necessary for the prompt recognition of this potentially devastating disease. Particularly, dentists and ophthalmologists should include TA in their differential diagnosis, as they may be the first to deal with these patients.     

Giant cell arteritis in two Chinese patients

Abstract Giant cell arteritis is virtually unknown in Orientals. We report two cases of histologically proven giant cell arteritis in two elderly Chinese men, one of whom presented with typical symptoms and the other with occult features of the disease.     

Influence of previous corticosteroid therapy on temporal artery biopsy yield in giant cell arteritis

OBJECTIVE: To determine the impact of prior corticosteroid treatment on temporal artery biopsy (TAB) yield to establish the diagnosis of giant cell arteritis (GCA). METHODS: Retrospective study of a consecutive cohort of 78 patients clinically diagnosed and managed as GCA, who received corticosteroids before TAB. RESULTS: Among the 78 patients, TAB was positive in 57 (73%) and negative in 21 (27%). No significant differences in the length of the specimen were found between the positive and negative biopsies. We grouped patients according to treatment duration before TAB. In those with newly diagnosed GCA treated with high-dose steroid therapy, the biopsy results were positive in 78% (35/45) of patients treated for less than 2 weeks, in 65% of those treated for 2 to 4 weeks (13/20), and in 40% of those treated for more than 4 weeks (2/5). We also observed 8 patients that developed GCA on a background of a prior history of polymyalgia rheumatica (PMR); in this group biopsy was positive in 88% of the cases, after a median duration of treatment of 180 +/- 172 days and an average daily dose of 7.1 +/- 1.4 mg/d. CONCLUSION: The performance of TAB should not delay the prompt institution of steroid therapy on diagnosis of GCA, since the diagnostic yield of TAB seems valuable within 4 weeks of starting high-dose steroid treatment. In patients that developed GCA on a background of a prior history of PMR, a late TAB is also generally informative despite long-term treatment with low doses of corticosteroids.     

Ketoprofen and ergotamine in acute migraine.

The objectives of this study were to evaluate and compare the efficacy and tolerability of ketoprofen and ergotamine in the treatment of acute migraine attacks without aura. The study design was a single-centre, double-blind, placebo-controlled, cross-over comparison of a single dose of ketoprofen (100 mg) and ergotamine (2 mg) suppositories in the treatment of acute migraine attacks. Fifty patients were included in the statistical evaluation. Ketoprofen was found to be more efficient than ergotamine and placebo in reducing the severity of pain. Ketoprofen was found to be more satisfactory than ergotamine and placebo with regard to influence on working ability, and better than placebo in global assessment. We conclude that ketoprofen (100 mg suppository) is superior to ergotamine (2 mg suppository) and placebo in the symptomatic treatment of acute migraine attacks, and has better tolerability.     

Temporal arteritis in Hong Kong

Objective: To evaluate Chinese patients with biopsy‐proven temporal arteritis in Hong Kong, focusing on clinical presentation, frequency of occurrence, treatment regimen and complications, management and outcome of these patients. Design: A retrospective study. Method: A retrospective study was undertaken in which patients with biopsy‐proven temporal arteritis were identified from: (i) Statistical records of Hospital Authority (1996–1999); (ii) pathology records of regional hospitals in Hong Kong (1996–2000); and (iii) case records from rheumatologists in two university hospitals. Indexed hospital and out‐patient records were reviewed and analysed. Results: Nineteen patients with biopsy‐proven temporal arteritis were identified from 1996 to 2000 and the calculated annual incidence was 0.34 patients in 100,000 people aged 50 and above per year. There were six male and 13 female patients (male : female ratio 1:2.2). Sixteen (84%) patients were older than 70 years. The common presentations were similar to overseas studies and included headache (79%), muscular symptoms (42%), constitutional symptoms (37%), scalp tenderness (37%), visual loss (32%), jaw claudication (32%), abnormal temporal artery (32%), and fever (26%). The mean erythrocyte sedimentation rate before treatment was 104 mm/h (SD = 30 mm/h). Anemia (Hb < 12 g/dL) was present in 79% of patients. The mean duration of symptoms before diagnosis was 8.4 weeks. Seventeen (89%) patients received high‐dose steroid therapy but none received steroid‐sparing agents. Only 33% of patients reached a physiological dose of steroid (prednisolone 5 mg/day) after 1 year. Conclusion: Temporal arteritis is rare among Hong Kong Chinese. A rough estimate of annual incidence yielded less than one per 100,000 people aged ≥ 50. Overall clinical presentation was similar to overseas studies but there were: (i) longer duration of steroid therapy given; and (ii) more complications from steroid use. Steroid‐sparing agents should be considered early in difficult‐to‐control cases.     

Temporal arteritis: the silent presentation and delay in diagnosis

To determine the frequency of the so-called silent or occult presentation of temporal arteritis (presentation with mere constitutional symptoms) and the resulting delay in diagnosis in this particular group, the medical records of all patients (n = 82) with temporal arteritis or polymyalgia rheumatica, presenting between 1982 and 1988 at the Department of General Internal Medicine of the University Hospital, were retrospectively analysed. Only biopsy-proven cases (n = 34) were studied further. Of the 34 patients with temporal arteritis, 13 (38%) presented with the silent or occult form. In this group the mean delay in diagnosis was 21.5 d (range 2-105) in contrast to a delay of 8.5 d (range 1-40) in the other group (P less than 0.05). Increased awareness of this presentation should lead to earlier diagnosis and treatment of this potentially life-threatening disease, resulting in a shorter hospital stay and fewer technical investigations, with a considerable financial saving.     

Methotrexate in refractory bilateral juvenile temporal arteritis: Report of a case

Juvenile temporal arteritis is a rare inflammatory disease of the temporal arteries that affects young adults. The clinical course is benign and the surgical excision of the affected artery is usually curative. Here we report a case of bilateral juvenile temporal arteritis with significant peripheral eosinophilia and elevated IgE, refractory to surgical excision and even to a short course of corticosteroids. Methotrexate, added as a steroid-sparing agent, resulted in a good disease control.     

Takayasu arteritis in Korea: Clinical and angiographic features

Clinical and angiographic features of Takayasu arteritis were investigated in 129 Korean patients. This disease affects females more frequently than males, in a ratio of 6.6 to 1. Of the total number of patients, 51 were in the third decade, 27 in the fourth decade, and 23 in the second decade. Common clinical symptoms were headache (60%), exertional dyspnea (42%), dizziness (36%), and malaise or weakness (34%). Takayasu arteritis affected the abdominal aorta (46%) and descending thoracic aorta (37%) more frequently than the ascending aorta (1%) and aortic arch (2%) According to Ueno's classification based on aortographic findings, the 129 patients were divided into type I (37), type II (25), and type III (67). Among the 48 patients who had coronary angiography, 11 (23%) showed coronary arterial involvement. Because the clinical features are determined by the extent and severity of the specific artery involved in the occlusive phase of the disease, total aortography including coronary angiography is very important in the initial evaluation of Takayasu arteritis.     

Concurrent occurrence of allergic granulomatous angiitis and temporal arteritis: a case report and review of the literature

Abstract

Allergic granulomatous angiitis (AGA) is a disease entity that was first distinguished from classical polyarteritis nodosa by Churg and Strauss in 1951, and is characterized by the clinical features of allergic rhinitis or bronchial asthma, eosinophilia, and vasculitis. Allergic granulomatous angiitis has been described to mainly involve small vessels. We herein describe a case of Churg–Strauss syndrome which demonstrated the clinical and laboratory findings supporting a diagnosis of AGA and was also associated with the clinical and pathological findings for temporal arteritis, which was characterized by eosinophil infiltration and granuloma formation of the temporal artery (middle-sized vessel).     

Concurrent occurrence of allergic granulomatous angiitis and temporal arteritis: a case report and review of the literature

Allergic granulomatous angiitis (AGA) is a disease entity that was first distinguished from classical polyarteritis nodosa by Churg and Strauss in 1951, and is characterized by the clinical features of allergic rhinitis or bronchial asthma, eosinophilia, and vasculitis. Allergic granulomatous angiitis has been described to mainly involve small vessels. We herein describe a case of Churg–Strauss syndrome which demonstrated the clinical and laboratory findings supporting a diagnosis of AGA and was also associated with the clinical and pathological findings for temporal arteritis, which was characterized by eosinophil infiltration and granuloma formation of the temporal artery (middle-sized vessel).     

Influence of corticosteroid treatment on MRI findings in giant cell arteritis

Giant cell arteritis (GCA) remains a diagnostic challenge. With the use of a high-resolution MRI protocol, visualization of the superficial cranial arteries is feasible and mural inflammation can be assessed noninvasively. Until today, it is not known how soon inflammatory signals in diagnostic MR imaging vanish after initiation of treatment. Here, we report sequential MR imaging findings during the initial weeks of corticosteroid treatment in a 79-year-old female patient with histologically proven GCA. Mural inflammatory changes decreased within the first 2 weeks and have almost entirely vanished after 2 1/2 months of continued treatment. Moreover, MR angiography revealed sequential stenoses of the subclavian artery, which improved in variable extent with some residuals despite high dose steroid medication. This report underlines the value of high-resolution MRI in diagnosis and follow-up of GCA and illustrates the potential of MRI to detect and monitor intra- and extra-cranial involvement patterns of GCA in high detail.     

Audit of the management of suspected giant cell arteritis in a large teaching hospital

Background : The diagnosis of giant cell arteritis (GCA) is often confirmed by an early temporal artery (TA) biopsy of adequate length. Treatment of this condition with high‐dose corticosteroids may be associated with significant morbidity, including osteo­porosis. Aim: To audit current management of patients with suspected GCA at Auckland Healthcare, a large teaching hospital. Methods: We performed a retrospective chart review of all TA biopsies from January 1996 to June 2000. A total of 117 biopsies from 111 patients was audited. Of these patients, 37/111 (33%) had a final clinical diagnosis of GCA (GCA patients). The areas of interest for audit were waiting time for TA biopsy, length of sample, initial corticosteroid therapy and osteo­porosis prophylaxis. Results: The mean waiting time for biopsy for all patients was 5.6 days (range 0?42 days). This time varied from 9.3 days for rheumatology patients to 2.6 days for ophthalmology patients (P = 0.003). Only 44/117 (37.6%) specimens measured more than 10 mm. For GCA patients, the median initial oral prednisone dose was 60 mg/day. Osteoporosis prophylaxis was prescribed in 24/37 (65%) GCA patients, most commonly cyclical etidronate. Conclusions: There is significant variation in the management of GCA within our institution. This audit has highlighted several areas where improvement could be made, particularly in streamlining the process of obtaining TA biopsy and in promoting the use of osteoporosis prophylaxis. (Intern Med J 2002; 32: 315?319)     

Arterial lesions in giant cell arteritis: A longitudinal study

Objectives

To evaluate large-vessel (LV) abnormalities on serial imaging in patients with giant cell arteritis (GCA) and discern predictors of new lesions.