[Clinical features and treatment of giant cell arteritis in Chinese, a prospective study]

To investigate the clinical features of giant cell (temporal) arteritis (GCA) in China.

The clinical manifestations, temporal artery biopsy, response to steroid therapy, and follow-up data of sixteen patients with the diagnosis of GCA from July 1999 to March 2001 were analyzed. The American College of Rheumatology (ACR) criteria for classification of GCA were used as reference.

Twenty-one patients who sought medical advice in the Second Hospital Affiliated to Xiangya Medical College were suspected of GCA. A definite diagnosis of GCA was made among sixteen patients. The diagnosis among 13 of them fulfilled the 1990 American College of Rheumatology criteria for the classification of GCA. The mean age at disease onset was 43.13 years (range 28 approximately 60 years) and 81.25% of the patients were under the age of 50 when they came down with the disease. The ratio between male and female cases was 15:1. The commonest initial clinical manifestations included newly occurring headache, temporal artery abnormality, visual symptoms, fever, and raised erythrocyte sedimentation rate. Jaw claudication, fatigue, syncope, and hemiparesis could be found in some patients. All the 16 patients underwent temporal artery biopsy. Light and electron microscopy showed inflammatory cell infiltration in arterial wall in 11 cases, fragmented internal elastica in 16 cases, fibrinoid necrosis in 3 cases, smooth muscle cell changes in 10 cases, and thrombosis in the lumen in 5 cases. The mean time from symptom onset to suspicion of GCA or biopsy was 5.52 months (range 0.25 approximately 24.33 months). The misdiagnosis rate during first visit was 87.50%.

GCA may not be a rare disorder in China. In comparison with the cases abroad, the Chinese GCA patients come down with disease at the earlier age, and most Chinese GCA patients are male. This disease is not understood by many clinicians in China. Misdiagnosis is common.