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[Horton's disease. Paucisymptomatic forms. Apropos of a series of 37 cases]
Insights
Giant cell arteritis (GCA), also known as Horton disease, presents diagnostic challenges in the elderly, particularly with its subtle or incomplete forms. Early recognition of these atypical presentations is crucial to avoid delayed treatment and potential complications.
Area of Science:
- Rheumatology
- Internal Medicine
- Geriatrics
Context:
- Giant cell arteritis (GCA), or Horton disease, is increasingly prevalent in elderly populations.
- Typical GCA presentations are often recognized, but atypical, incomplete, or paucisymptomatic forms pose diagnostic difficulties.
Purpose:
- To discuss the challenges in diagnosing occult and misleading forms of GCA.
- To categorize these atypical presentations based on clinical features and literature review.
Summary:
- The study reviews 37 personal cases and existing literature on paucisymptomatic and misleading GCA presentations.
- These atypical forms are categorized into ocular, febrile/anemic monosymptomatic, extraocular ischemic, and pseudotumoral subtypes.
- Accurate diagnosis is essential to prevent severe consequences of delayed treatment and avoid unnecessary invasive investigations.
Impact:
- Highlights the importance of recognizing subtle GCA manifestations in elderly patients.
- Aids clinicians in identifying and managing challenging GCA cases, potentially improving patient outcomes.
- Emphasizes the need for timely diagnosis to initiate effective GCA therapy and prevent serious sequelae.
Abstract:
Giant cell arteritis (Horton disease) is of growing significance among conditions met in elderly patients. Typical forms are no longer overlooked but occult or incomplete forms, in which one or more characteristic features are lacking, are misleading and may result in a dramatically effective therapeutic decision being deferred. These paucisymptomatic or misleading forms of giant cell arteritis are discussed with reference to 37 personal cases and a review of the medical literature. They have been categorized into ocular, febrile or anemic monosymptomatic forms, extraocular ischemic forms and pseudotumoral forms. Correct diagnosis is worthwhile, in order to avoid the serious consequences of overlooked disease and unnecessary traumatic investigations.