GIANT CELL (TEMPORAL) ARTERITIS - 11/09/11

Doi : 10.1016/S0733-8619(05)70354-6

Richard J. Caselli, MD ^a,^b, Gene G. Hunder, MD ^c,^d

^a Department of Neurology (RJC), Mayo Medical School

^b Division of Behavioral Neurology (RJC), Mayo Clinic, Scottsdale, Arizona

^c Mayo Medical School (GGH)

^d Division of Rheumatology (GGH), Rochester, Minnesota

Résumé

Giant cell (temporal) arteritis (GCA) is a well-recognized cause of headache, polymyalgia rheumatica (PMR), inflamed superficial temporal arteries, and jaw claudication in an elderly patient with a high erythrocyte sedimentation rate (ESR). The diagnosis can be confirmed by temporal artery biopsy (TAB), and treatment with oral corticosteroids usually relieve symptoms and prevent vasculitic complications.

Yet GCA can pose difficult diagnostic and therapeutic problems. Diagnostically, many symptoms that are typical of GCA are nonspecific. Headache, the most common symptom in patients with GCA^{12 Caselli R.J., Hunder G.G., Whisnant J.P. Neurologic disease in giant cell (temporal) arteritis Neurology 1988 ; 38 : 352

Cliquez ici pour aller à la section Références} and the most frequent reason patients seek neurologic consultation,^{35 Hollenhorst R.W., Brown J.R., Wagener H.P. , et al. Neurologic aspects of temporal arteritis Neurology 1960 ; 10 : 490

Cliquez ici pour aller à la section Références} can accompany innumerable other diseases. There are no specific noninvasive tests for GCA. The ESR is increased in 97% of patients with GCA,^{12 Caselli R.J., Hunder G.G., Whisnant J.P. Neurologic disease in giant cell (temporal) arteritis Neurology 1988 ; 38 : 352

Cliquez ici pour aller à la section Références} so a normal ESR may bring the diagnosis into question, but only a TAB offers confirmatory evidence for GCA.^{28 Hall S., Hunder G.G. Is temporal artery biopsy prudent [editorial]? Mayo Clin Proc 1984 ; 59 : 793

Cliquez ici pour aller à la section Références, 29 Hall S., Persellin S., Lie J.T. , et al. The therapeutic impact of temporal artery biopsy Lancet 1983 ; 2 : 1217 [cross-ref]

Cliquez ici pour aller à la section Références} In one large series^{12 Caselli R.J., Hunder G.G., Whisnant J.P. Neurologic disease in giant cell (temporal) arteritis Neurology 1988 ; 38 : 352

Cliquez ici pour aller à la section Références} a third of TABs performed over a 3-year period showed vasculitis. Many physicians are reluctant to perform an invasive test with a 67% chance of a negative result. Some patients have unusual manifestations that are nonspecific for GCA, including stroke which is also endemic in the elderly. It can be difficult, impossible, or erroneous in any one patient to ascribe GCA as the one and only cause of stroke in a particular patient. Many clinicians assume that GCA does not lead to neurologic problems other than certain well-recognized neuro-ophthalmologic disorders. As usual, a middle ground is needed based on an appreciation of the neurologic complications that are caused by GCA and its treatment, and other comorbid illnesses.