CHAPTER 16 TEMPORAL GIANT CELL ARTERITIS Robert A. Duarte, MD, Charles E. Argoff, MD 1. what is giant cell arteritis (GCA)? Giant cell arteritis (GCA), also known as temporal arteritis (TA), is a specific form of vasculitis seen primarily in the older adult population, with a mean age of about 70 years at the time of diagnosis. However, there are documented cases of patients in their 40s with TA. It is more commonly seen in northern geographical latitudes, most commonly in people of British or Scandinavian heritage. TA is rarely seen in Asians and African-Americans. The disease is characterized pathologically by granulomatous inflammation of medium-sized arteries, resulting in the formation of multinucleated giant cells. TA can affect any artery, but it is primarily a disease of the aortic arch and its branches and not simply of the superficial temporal artery; hence the synonymous term giant cell arteritis (GCA). TA/GCA should be high on the differential diagnosis list of any person over the age of 60 presenting with new-onset headaches or any person with preexisting chronic headaches and a new headache subtype. 2. What are the most common presenting symptoms seen in giant cell arteritis? In 70% of patients headache is the most common symptom. The classic “textbook” description is of superficial scalp pain or soreness in the temporal region that is sensitive to touch. Patients will often describe a scalp or ear sensitivity, felt especially when combing there hair or wearing a hat. However, in most cases, the pain is nonspecific and not well localized. Jaw claudication (pain with chewing) is almost pathognomonic but is seen in only 40% of patients. Tongue claudication occurs in about 4% of patients. Accompanying symptoms may include generalized malaise, anorexia, and muscle pains. Occasionally, visual symptoms are the presenting complaint; this scenario is the most ominous in terms of outcome. 3. Are there any clinical features that are most predictive of the presence or absence of TA? Yes. When evaluating the patient with a complaint of headache, elevated erythrocyte sedimentation rate, advanced age, jaw claudication, and diplopia have the best positive predictive value for TA. Normal sedimentation rates markedly diminish the probability that the patient has TA. 4. What are the common physical findings in giant cell arteritis? Signs in GCA depend on the vessels involved and the end-organ damage sustained. The term temporal arteritis is a misnomer because this condition can involve many other arteries. The temporal artery itself is superficial and may be palpable, hard, and tender. Other signs may include fever, carotid bruits in up to 20% of affected individuals, papilledema, and extraocular muscle paresis. 5. Are there neurological complications of giant cell arteritis? Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Neuroimaging in the Patient with Pain Cluster Headache Postoperative Pain Management Sympathetic Neural Blockade Cancer Pain Syndromes Temporary Neural Blockade Stay updated, free articles. Join our Telegram channel Join Tags: Pain Management Secrets Jun 14, 2016 | Posted by admin in PAIN MEDICINE | Comments Off on Temporal Giant Cell Arteritis Full access? Get Clinical Tree
CHAPTER 16 TEMPORAL GIANT CELL ARTERITIS Robert A. Duarte, MD, Charles E. Argoff, MD 1. what is giant cell arteritis (GCA)? Giant cell arteritis (GCA), also known as temporal arteritis (TA), is a specific form of vasculitis seen primarily in the older adult population, with a mean age of about 70 years at the time of diagnosis. However, there are documented cases of patients in their 40s with TA. It is more commonly seen in northern geographical latitudes, most commonly in people of British or Scandinavian heritage. TA is rarely seen in Asians and African-Americans. The disease is characterized pathologically by granulomatous inflammation of medium-sized arteries, resulting in the formation of multinucleated giant cells. TA can affect any artery, but it is primarily a disease of the aortic arch and its branches and not simply of the superficial temporal artery; hence the synonymous term giant cell arteritis (GCA). TA/GCA should be high on the differential diagnosis list of any person over the age of 60 presenting with new-onset headaches or any person with preexisting chronic headaches and a new headache subtype. 2. What are the most common presenting symptoms seen in giant cell arteritis? In 70% of patients headache is the most common symptom. The classic “textbook” description is of superficial scalp pain or soreness in the temporal region that is sensitive to touch. Patients will often describe a scalp or ear sensitivity, felt especially when combing there hair or wearing a hat. However, in most cases, the pain is nonspecific and not well localized. Jaw claudication (pain with chewing) is almost pathognomonic but is seen in only 40% of patients. Tongue claudication occurs in about 4% of patients. Accompanying symptoms may include generalized malaise, anorexia, and muscle pains. Occasionally, visual symptoms are the presenting complaint; this scenario is the most ominous in terms of outcome. 3. Are there any clinical features that are most predictive of the presence or absence of TA? Yes. When evaluating the patient with a complaint of headache, elevated erythrocyte sedimentation rate, advanced age, jaw claudication, and diplopia have the best positive predictive value for TA. Normal sedimentation rates markedly diminish the probability that the patient has TA. 4. What are the common physical findings in giant cell arteritis? Signs in GCA depend on the vessels involved and the end-organ damage sustained. The term temporal arteritis is a misnomer because this condition can involve many other arteries. The temporal artery itself is superficial and may be palpable, hard, and tender. Other signs may include fever, carotid bruits in up to 20% of affected individuals, papilledema, and extraocular muscle paresis. 5. Are there neurological complications of giant cell arteritis? Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Neuroimaging in the Patient with Pain Cluster Headache Postoperative Pain Management Sympathetic Neural Blockade Cancer Pain Syndromes Temporary Neural Blockade Stay updated, free articles. Join our Telegram channel Join Tags: Pain Management Secrets Jun 14, 2016 | Posted by admin in PAIN MEDICINE | Comments Off on Temporal Giant Cell Arteritis Full access? Get Clinical Tree
