Controversies regarding Giant cell (Temporal, Cranial) arteritis

Abstract

It is important to establish the diagnosis of temporal arteritis because the disease is treatable; treatment may prevent blindness and even death. Temporal arteritis usually occurs in people older than 51 years of age, although very rarely, histologically documented disease occurs in younger people. The onset may be occult, so that there are few findings. A multitude of signs and symptoms may occur such as fever, headaches, malaise, weight loss, anemia, stroke, cranial nerve palsies, polymyalgia rheumatica, aortitis and other large vessel involvement. The eye may suffer from ischemic optic neuropathy (anterior or posterior), central or cilio-retinal arterial occlusion, ophthalmic artery ischemia, or extraocular muscle palsies. An arterial biopsy showing giant cell arteritis establishes the diagnosis. However, a negative biopsy does not rule out the disease because of the occasional presence of skip areas. Arteriography has only rarely yielded a positive temporal artery biopsy when the initial biopsy done elsewhere was negative. As a diagnostic parameter, the erythrocyte sedimentation rate is nonspecific, being elevated in diseases other than temporal arteritis and sometimes being falsely lowered by technical factors. Furthermore, the temporal artery biopsy is occasionally positive despite a normal erythrocyte sedimentation rate. Treatment is aimed at relieving the patient's symptoms and normalizing the erythrocyte sedimentation rate. Because of the wide spectrum of clinical and laboratory finding in temporal arteritis, no one specific treatment regimen with systemic corticosteroids works for all patients. Temporal arteritis is a well known disease of the elderly which ir rarely fatal but results in significant visual morbidity (Hinzpeter & Naumann, 1976; Spencer & Hoyt, 1960). Since Hutchinson's (1890) description, more than a thousand articles have been written on the subject (Cohen & Smith, 1974). Despite this, many unanswered questions and controversies remain concerning the diagnosis, prognosis and treatment of temporal arteritis. My goal is to review these questions and areas of controversy.

Window to the circulatory system: Ocular manifestations of cardiovascular diseases

“…It is characterized by granulomatous inflammation of the blood vessels and is rarely found in individuals below 50 years of age. 62 GCA most commonly presents with systemic symptoms like headache, jaw claudication, scalp tenderness, or constitutional symptoms (fever, fatigue, weight loss). Although a significant proportion of patients with GCA present with visual symptoms ranging between 20% and 50%.…”

Optic Neuropathy Secondary to Polyarteritis Nodosa, Case Report, and Diagnostic Challenges

“…Unfortunately, our diagnosis could not be confirmed with histopathologic examination of the optic nerve or angiographic tests. Regardless, ION was discarded due to the fact that although patients can display similar manifestations ( 17 ), visual loss and prognosis are often worse since the damage to the optic nerve is irreversible, causing progressive visual loss characterized by a pale and swollen optic disk ( 18 , 19 ). Additionally, disk edema tends to be sectoral in the affected eye and usually there is a small cup-to-disk ratio, whereas the less or non-affected eye will present with a normal or enlarged cup ( 20 ), which was absent in our case.…”

Neurological Complication of Infective Endocarditis Mimicking Temporal Arteritis

“…In fact, personal history of polymyalgia, presence of inflammatory markers and evidence of retinal ischemia at first suggested the diagnosis of temporal arteritis. This vasculitis may present with systemic signs such as anemia, fever, headache, stroke and polymyalgia [7] . Moreover, ocular symptoms (from ischemic optic neuropathy to retinal artery occlusion) are often present in temporal arteritis [8,9] .…”