Arm ischemia secondary to giant cell arteritis

Six cases of arterial insufficiency of the arm secondary to giant cell arteritis are described, all in elderly white women. The clinical presentation of the occlusive disease ranged from an asymptomatic incidental physical finding to an alarming picture of severe ischemia. All patients were treated with steroids and had subsequent stabilization or improvement of extremity symptoms. Vascular reconstruction was also performed in two patients, one of whom developed rest pain after graft occlusion. Another patient had a cerebral infarction while taking prednisone, despite control of large vessel vasculitis. This study indicates that giant cell arteritis should be considered in cases of occlusive disease of the arms, especially in elderly women. Giant cell arteritis is a seriously morbid and potentially fatal disease which justifies a thorough evaluation when sufficient evidence is present to suggest the diagnosis. The response to steroids is usually adequate to eliminate the need for early surgical intervention.