What Are the Most Common Temporal Arteritis Symptoms?

Giant cell arteritis (GCA) used to be called cranial arteritis, temporal arteritis, granulomatous arteritis, and later recognized that any larger artery in the body can be affected, and named for its pathological characteristics. The cause of GCA is unknown and is the most common systemic vasculitis in adults. The disease mainly involves extracranial branches of the carotid artery in patients over 50 years of age. The most serious complication of GCA is irreversible vision loss.

Basic Information

nickname: Cranial arteritis, temporal arteritis, granulomatous arteritis
English alias: giant cell arteritis, GCA
Visiting department: Division of Rheumatology

Multiple groups: Patients over 50 years
Common symptoms: Headache, insufficient blood supply to other cranial arteries, depression, memory loss, insomnia, etc.

Causes of giant cell arteritis

The cause of GCA is unknown. The greatest risk factor for GCA is advanced age. The disease never occurs before the age of 50, and its incidence has steadily increased since the age of 50. Ethnicity, region, and ethnicity are also important morbidity factors, with the highest incidence seen in Scandinavian and Scandinavian immigrant descent in the United States. The occurrence of GCA is also genetically susceptible. Recent studies have confirmed that GCA is related to genes in the human leukocyte antigen class II region. Familial morbidity investigation found that the first-degree relatives of GCA patients had more morbidity, and most of them had HLA-DR4 and CW3, suggesting genetic susceptibility. In addition, the onset of GCA also has environmental risk factors, as well as gender and health status.

GCA inflammatory response is concentrated in the elastic membrane of arteries, which may be related to some of its autoantigens. Immunohistochemical studies have also found that immunoglobulin is deposited in the inflammatory temporal artery wall. TH cells are the main infiltrating inflammatory cells. Lymphocytes in the peripheral blood of patients are sensitive to human arteries and myoplasmin in test tubes.

Clinical manifestations of giant cell arteritis

The average age of onset of GCA is 70 years (between 50 and 90 years). More women than men (2: 1). The onset of GCA may be sudden, but most patients have a course of disease and clinical symptoms such as fever (low or high fever), fatigue, and weight loss before the diagnosis is confirmed. The symptoms associated with affected arteritis are typical manifestations of GCA.

Headache

It is the most common symptom of GCA. It is tension pain on one or both sides of the temporal, forehead or occipital region, or superficial burning pain, or paroxysmal tear-like pain, redness and swelling of the skin in the pain area, and tenderness and tenderness. Sometimes it can touch the scalp nodules or nodular superficial temporal arteries.

2. Other cranial arterial insufficiency symptoms

When the blood supply to the masticatory muscles, the swallowing muscles and the tongue muscles is insufficient, typical intermittent exercise pauses are shown, such as chewing pauses and swallowing or language pauses due to chewing muscle pain. Involvement of the posterior ciliary artery, branch eye artery, retinal artery, and occipital cortex artery can cause diplopia, drooping eyelids, or visual impairment. 10% to 20% of patients with GCA have one or both sides of blindness, or have transient vision impairment, blackout and other threats. Blindness is one of the serious complications of GCA. One side blindness cannot be treated in time, contralateral blindness often occurs within 1 to 2 weeks, and 8% to 15% of GCA patients have permanent blindness. Therefore, the diagnosis and early treatment of GCA are important principles for the prevention and treatment of blindness. Some patients may experience symptoms such as ear pain, dizziness, and hearing loss.

3. Other arterial involvement

10% to 15% of GCA shows signs of insufficient blood supply to the arteries of the upper and lower limbs, intermittent dyskinesias of the upper limbs, or intermittent claudication of the lower limbs; when the carotid, subclavian, or axillary arteries are involved, vascular noise can be heard, and the pulsation is weakened or pulsed. Disappearance (apulse), etc .; When the aortic arch or aorta is involved, it can cause the aortic arch wall layer to separate, resulting in an aneurysm or dissection aneurysm, which requires an angiographic diagnosis.

4. Central nervous system performance

GCA may have symptoms such as depression, memory loss, and insomnia.

Giant cell arteritis

GCA has no specific experimental indicators. It only has mild to moderate orthochromic angioblastic anemia, mild decrease in serum albumin, plasma protein electrophoresis showing increased 2 globulin, and slight increase in serum transaminase and alkaline phosphatase activities. The most prominent experimental abnormalities are the rapid increase in erythrocyte sedimentation (the GCA active period is often as high as 100 mm / h), and the quantitative increase of C-reactive protein.

Arterial biopsy

Superficial temporal or occipital artery biopsy is the most reliable way to diagnose GCA. The positive rate of superficial temporal artery biopsy is between 40% and 80%, and the specificity is 100%. Because the GCA lesions have a segmental jump distribution, a few centimeters of length should be taken during biopsy. It is advisable to use the site with tenderness or nodularity and perform continuous pathological sectioning to improve the detection rate. Temporal artery biopsy is safer, and biopsy on one side can be performed on the other side or occipital artery biopsy.

2. Temporal Arteriography

It is of certain value for the diagnosis of GCA. It can find changes in lumen irregularity and stenosis of the temporal artery, and can also be used as an indication of the site of the temporal artery biopsy.

3. Selective aortic angiography

Selective angiography may be performed when aortic involvement is suspected, such as aortic arch and its branch arteriography.

Giant cell arteritis diagnosis

Elderly people over 50 years old with unexplained fever, burnout, weight loss, anemia, ESR> 50mm / h; recent headaches, visual disturbances (black, blurred vision, diplopia, blindness); or other cranial arteries Signs of insufficient blood supply, such as masticatory muscle intermittent arterial disorders, tinnitus, dizziness, etc., or the presence of PMR syndrome should be suspected of this disease, and grasp for further examination, such as temporal arteriography, temporal artery thrombus, to determine the diagnosis. If conditions do not allow, glucocorticoid therapy can be tried after excluding other rheumatic diseases.

Differential diagnosis of giant cell arteritis

GCA should be distinguished from other vascular inflammatory diseases:

Nodular polyarteritis

The disease mainly invades the small and medium arteries, such as the renal, celiac, or mesenteric arteries, and rarely involves the temporal arteries.

2. Allergic vasculitis

The disease mainly involves skin small blood vessels, small veins or capillaries, with obvious skin lesions such as maculopapular papules, pimples, purpura, ecchymosis, nodules, ulcers and so on.

3. Granulomatous polyangiitis (Wegener's granulomatosis)

Above, lower respiratory tract necrotizing granuloma, generalized small and medium arteritis, and focal necrotizing glomerulonephritis are the main features.

4. Aortic arch arteritis

Aortic arch arteritis has a wide range of lesions, often causing arterial segmental stenosis, arterial dilatation before and after occlusion, etc. GCA invasion of the aorta is rare. In addition, it should be distinguished from malignant tumors, systemic or systemic infections, or other causes of fever, headache, anemia, and blindness.

Giant cell arteritis treatment

GCA often invades multiple arteries and is prone to serious complications such as blindness. Therefore, glucocorticoid therapy should be given once the diagnosis is clear. It is generally advisable to use large-dose continuous therapy, such as prednisone, to maintain symptoms until the symptoms ease, and the blood sedimentation drops to normal or close to normal. Begin the reduction. The total course of treatment takes several months. It should not be prematurely reduced or discontinued to prevent relapse. . Once the condition is stable, switching to one-time administration in the morning or switching to alternate-day therapy is the most effective option. Although non-steroidal anti-inflammatory drugs such as indomethacin can alleviate or control some symptoms, such as antipyretic, analgesic, and improve general discomfort, they cannot prevent ischemic complications such as blindness. For those with contraindications to glucocorticoids, a combination of nonsteroidal anti-inflammatory drugs and cytotoxic immunosuppressants such as cyclophosphamide and methotrexate can be used. You can also try triptolide treatment.

Prognosis of giant cell arteritis

GCA responds well to glucocorticoids, can quickly control the disease, reduce and prevent serious complications such as blindness, and generally has a good prognosis. A small number of light cases have some self-limiting.