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[Diagnosis ex juvantibus-- an observation on giant cell arteritis]
Insights
Giant cell arteritis presents polymorphously, especially in the elderly. Temporal artery biopsy may not be essential; steroid therapy with clinical monitoring is a proposed alternative for geriatric patients.
Area of Science:
- Geriatric Medicine
- Rheumatology
- Pathology
Background:
- Giant cell arteritis (GCA) diagnosis and treatment in a nursing home setting.
- Emphasis on the polymorphous nature of GCA, challenging diagnostic norms.
Observation:
- Questioning the absolute necessity of temporal artery biopsies, particularly in elderly patients.
- Critique of diagnostic criteria (Mayo Clinics, 1978) for temporal artery biopsies, noting limitations in considering lesion localization.
- Acknowledging variant and masked forms of GCA and doubts regarding temporal artery biopsy efficacy.
Findings:
- Proposes steroid therapy as an alternative diagnostic and management approach for elderly patients with suspected GCA.
- Advocates for careful clinical and biochemical monitoring during steroid therapy.
Implications:
- Suggests a shift from rigid diagnostic protocols to a more flexible, patient-centered approach in geriatric rheumatology.
- Highlights the importance of considering atypical presentations and alternative diagnostic strategies for GCA in the elderly population.
Abstract:
On the basis of some cases of presumable giant cell arteritis, which were diagnosed and treated in a nursing home, the polymorphous character of this affection is emphasized. The author poses that biopsies of the temporal artery--certainly with elderly people--shouldn't be regarded as an absolute necessity and he refers in this context to the discussion held about it in the Dutch Magazine of Medicine (Nederlands Tijdschrift voor Geneeskunde, 126, 1982, 14, p. 636-637). It is remarkable in this discussion that advocates of the possibly even double-sided temporal biopsies (!) refer to the criteria of the Mayo Clinics (1978), which on further consideration, don't seem to be quite sound and, to say the least of it, don't very much take into account the localization of the arterial lesions outside the well-known ones. Several other authors appear to take full account of the variant and masked forms and have their doubts about the efficiency of the temporal artery biopsy. Where giant cell arteritis concerns mostly elderly people and the geriatric approach and solution of this and other medical problems in general sometimes are contrary to the current 'formal-clinical' attitude, the author thought it right to propose an alternative for the elderly advances in years: the trial of steroid therapy, keeping a conscientious control on the clinical picture and the biochemical symptoms.