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[Inaugural symptoms of Horton's disease in a series of 260 patients]
C Becourt-Verlomme1, R Barouky, C Alexandre
1Service de médecine interne, hôpital Lyon-Sud, 69495 Pierre-Bénite, France.
Insights
Giant cell arteritis, or Horton disease, often presents with atypical symptoms. Recognizing these, such as cough or arthritis, is crucial for timely diagnosis and treatment with corticosteroids.
Area of Science:
- Rheumatology
- Internal Medicine
- Geriatrics
Context:
- Horton disease (giant cell arteritis) diagnosis can be challenging due to atypical presentations.
- A retrospective review of 260 patient files from 1979-1999 across internal medicine, rheumatology, and geriatric departments was conducted.
Purpose:
- To highlight the diagnostic challenges posed by atypical signs and symptoms of Horton disease.
- To emphasize the importance of recognizing less common manifestations for prompt diagnosis.
Summary:
- The study analyzed 260 Horton disease cases, predominantly affecting females aged 75.
- Atypical symptoms included neurological (4 patients), cutaneous (5 patients), and renal (2 patients) manifestations.
- Cough (21 cases) and peripheral arthritis (9 cases) were frequent, with positive temporal artery biopsies in 57% and 70% respectively, responding to corticosteroids and NSAIDs.
Impact:
- Increased awareness of atypical Horton disease symptoms can improve diagnostic accuracy.
- Early diagnosis and initiation of corticosteroid therapy are vital for managing giant cell arteritis.
- This research aids clinicians in identifying and treating patients with less common presentations of Horton disease.
Purpose:
Horton disease or 'giant cell arteritis' is a known entity in its typical form; the difficulty in diagnosis is due to the atypical signs and symptoms.
Methods:
We review 260 medical files presenting Horton disease between 1979 and 1999 in five different departments: three internal medicine departments, one rheumatology department and one geriatric department.
Results:
The study shows a female domination with a mean age of 75 years. Temporal artery biopsy was done on all patients. Ten patients presented a vascular manifestation. The neurological manifestation was the first symptom in four patients. Five patients had cutaneous symptomatology, with positive temporal artery in three cases. Renal manifestation was present in two patients. Two symptoms are important to discuss because of their frequency: the cough and the peripheral arthritis. We found nine observations with arthritis affecting large joints and responding to nonsteroidal antiinflammatories with positive temporal artery biopsy in seven patients, and 21 observations manifesting by cough without radiological signs; in 57% of cases the temporal artery biopsy was positive, and the cough regressed with corticoids.
Conclusion:
These atypical symptoms have to be known to make a diagnosis and to begin a corticotherapy as soon as possible.
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