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Giant cell arteritis without clinically evident vascular involvement in a defined population.
Miguel A Gonzalez-Gay1, Carlos Garcia-Porrua, Juan C Amor-Dorado
1Hospital Xeral-Calde, Lugo, Spain. miguelaggay@hotmail.com
Arthritis and Rheumatism
|April 13, 2004
Summary
Giant cell arteritis (GCA) without obvious vascular symptoms is not rare. Patients with biopsy-proven GCA and polymyalgia rheumatica (PMR) often experience delayed diagnosis but have a milder disease course.
Area of Science:
- Rheumatology
- Internal Medicine
- Vasculitis
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large arteries.
- Overt vascular manifestations are common in GCA, but some patients present without them.
Purpose of the Study:
- To determine the frequency and clinical characteristics of biopsy-proven GCA patients lacking overt vascular symptoms.
- To compare these patients with GCA patients who do exhibit vascular involvement.
Main Methods:
- Retrospective analysis of biopsy-proven GCA cases diagnosed between 1981 and 2001.
- Inclusion criteria for 'no evident vascular involvement' required absence of cranial ischemic events or other GCA vascular complications at diagnosis and during 12-month follow-up.
Main Results:
- Out of 210 biopsy-proven GCA patients, 11 (5.2%) had no overt vascular manifestations.
- Nine of these 11 patients presented with polymyalgia rheumatica (PMR); two had fever of unknown origin.
- Patients without vascular involvement showed a significantly longer delay in diagnosis and more frequent PMR symptoms.
Conclusions:
- Biopsy-proven GCA without clinically evident vascular involvement occurs in a notable proportion of patients.
- This subgroup, despite a delayed diagnosis, appears to represent a more benign clinical presentation of GCA.