Giant cell arteritis is often overlooked when it is too late (Rheumatology and Immunology)

Giant cell arteritis Considered emergency drills in rheumatology, but it is not always diagnosed before irreversible changes occur.

Giant cell arteritis * (HCA) - primarily a disease of older people - is a systemic vasculitis mainly characterized by inflammation of the large and middle cerebral arteries, especially the blood vessels at the temples. Although genetic, infectious and autoimmune factors play in the pathogenesis of the disease known role - its cause remains unsolved. If the disease is not diagnosed and treated - it can lead to irreversible vision loss as a result of necrotic posterior ciliary branches of the ophthalmic artery.

The key to early recognition of the HCA is in the doctor's awareness of the characteristic ocular and systemic symptoms of the disease, their consideration in the differential diagnosis when an elderly patient arrives with several non-specific complaints, said Dr. A. Stephen A. Paget, program director of the arthritis center at Cornell University and the Multipurpose Arthritis Center and diseases of the locomotor apparatus at the Hospital for Special Surgery ** in New York. Because of the variability of symptoms, however - "Patients with HCA can walk to many physicians in key, but not limited to, internist, ophthalmologist, neurologist, otolaryngologist, dentist and rheumatologist yet diagnosed - he says, noticing, that diagnosis.

Dr. Stephen answered a few questions for the publication of Internal Medicine News about the diagnosis and treatment of HCA.

Q: How common is the HCA, and what its major symptoms?

Dr. Paget: HCA often sochetaetsya with polymyalgia rheumatica. Half of the patients have symmetric proximal pain, stiffness, and 5-10% with polymyalgia rheumatica year after it began to develop temporal arteritis.

Painting HCA also includes other symptoms: severe and persistent headaches, pain in the jaw during meals, sore tongue, a sudden loss of vision (passing or permanent), flashing lights before your eyes, fever, weakness and weight loss.

Q: What are the diagnostic criteria for the HCA?

Dr. Paget: Criteria of the American College of Rheumatology in 1990 require three pinktov of the following: age 50 years or older, the appearance of localized headache, sensitivity of temporal artery on palpation or weakened its ripple, ESR 50 mm / hour or more and / or; the positive results of temporal artery biopsy.

Q: What are the current standard treatments for this condition perimenopausal basic antirheumatic drugs that modify the course of the disease (BPRP)?

Dr. Paget: Prednisolone is still an excellent drug against HCA and should be appointed immediately after the clinical diagnosis pending the results of the biopsy. Moreover, the characteristic dramatic improvement within 1-3 days after the start of steroid therapy helps to confirm the diagnosis. Methotrexate and azathioprine can izpolzovatsya in combination with steroids, but they should not be prescribed initially.

Question: What is the prognosis for patients who were examined and treated in time?

Dr. Paget: HCA, usually last a year or two, after which patients can do without drugs. The probability of recurrence is very small.

* Giant cell (giganto kletochny), temporal (temporal) arteritis (GTA), or Horton's disease - a systemic disease almost exclusively of elderly or old age, characterized by granulomatous inflammation gigantnokletochnym predominantly extra-and intracranial vessels affects the arteries elastic and the mixed type, usually one or more branches of the carotid arteries. In particular, often suffer temporal artery.

Hospital for Special Surgery (Hospital for Special Surgery) - is the oldest orthopedic hospital in the United States. It Furthermore, specializes in rheumatic conditions.

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