[A case of temporal arteritis associated with marked elevation of serum IgG, IgA levels]

An 84-year-old woman was admitted to Tokyo Metropolitan Tama Geriatric Hospital because of knee pain, anemia and hyperglobulinemia. On physical examination, evidence of arthritis was observed in both knees. Nodular temporal arteries were palpable with hypertrophy and weak pulsation. The urine was normal except that the sediment contained 20-30 with blood cells per high power view. Laboratory data showed raised erythrocyte sedimentation rate of 150 mm per hour, elevation of beta and gamma globulin and mild anemia. Although the levels of serum IgG, IgA were markedly increased, there was no monoclonal component on immunoelectrophoresis. Light microscopy examination of an aspirated specimen of bone marrow showed slight hypocellularity and mild plasmacytosis. However, atypical plasma cells were not observed. Radiographs of the knee showed narrowing of the joint space and calcification of articular cartilage and meniscus. Biopsy of the left temporal artery revealed typical findings of giant cell arteritis. The administration of prednisolone resulted in rapid normalization of laboratory findings. But her arthralgia, which had been relieved by analgesics after admission, was worsened if she took prednisolone without analgesic. Therefore, analgesics were given again with prednisolone for the control of the arthralgia.