Large-vessel GCA or a late presentation of Takayasu's arteritis?

Area of Science:

• Rheumatology
• Cardiology
• Vascular Medicine

Background:

• Giant cell arteritis (GCA) is a large-vessel vasculitis often presenting with cranial symptoms.
• GCA can involve medium and large arteries, potentially leading to limb claudication and ischemic events.
• Diagnosis typically relies on clinical criteria and temporal artery biopsy, though biopsy may not always alter management.

Observation:

• A patient presented with acute coronary syndrome and absent upper limb pulses.
• Clinical presentation and American College of Rheumatology criteria suggested both GCA and Takayasu's arteritis.
• Temporal artery biopsy was considered but deemed unnecessary for management decisions.

Findings:

• High-dose prednisolone (60 mg daily) was initiated for suspected GCA.
• Rapid reduction in erythrocyte sedimentation rate (ESR) was observed within 2 days (to 66 mm/h) and sustained by day 11 (to 4 mm/h).
• Clinical improvement correlated with decreased inflammatory markers.

Implications:

• This case highlights the importance of considering GCA in patients with atypical presentations, including coronary syndromes and peripheral vascular findings.
• Prompt initiation of corticosteroid therapy can effectively manage GCA and reduce systemic inflammation.
• The findings underscore the role of inflammatory markers like ESR in monitoring treatment response for large-vessel vasculitis.