Giant cell arteritis: Diagnostic approach based on a retrospective study on 21 cases

To describe diagnostic and therapeutic difficulties encountered in the management of giant cell arteritis (GCA).

We retrospectively included patients with GCA based on the 1990 ACR criteria, who were followed in the Internal Medicine Department of Mohamed Tahar Maamouri Hospital in Nabeul, Tunisia, over a 5-year period, from 1st January 2014 to 1st January 2019.

Twenty-one patients (16 women and 5 men) were included. The average age at diagnosis was 70 years. Predominant revealing symptoms were headache reported in 13 cases and ocular manifestations in 11 cases. Jaw claudication, scalp hyperesthesia and polymyalgia rheumatica were noted in 8 cases each. Ocular manifestations included acute anterior ischemic optic neuropathy in 8 cases, retrobulbar optic neuritis in 3 cases and central retinal artery occlusion in a single case. Inflammatory syndrome was consistently noted. Doppler ultrasound showed temporal artery 'halo sign' in one case and stenosis of the external carotid in another. In computed tomography (CT) scan, we found a thoracic aortitis in one case and an aortic ectasia in another. Temporal artery biopsy contributed to the diagnosis in 9 cases. Corticosteroid therapy was prescribed for all patients, preceded by three methylprednisolone pulses in 5 cases. Osteoporosis, steroid-induced diabetes and infections were the main adverse effects noted respectively in 14, 8 and 4 cases. Improvement was noted in 19 cases. Blindness was noted in two cases due to delayed consultation. Methotrexate was introduced in four patients for disease relapse.

Although rare in Tunisia, GCA remains a medical emergency because of the risk of sudden irreversible sight loss and stroke.