Presentation of occult giant cell arteritis

Temporal headache, blindness, and polymyalgia rheumatica are well-recognized manifestions of giant cell arteritis. However, the disease may present in less evident fashion as shown by 30 of 74 patients with biopsy-proven giant cell arteritis whose predominant complaint was not one ot these cardinal symptoms. For this group of 30, the main problem was fever in 12 patients, anorexia, weight loss, and elevated serum alkaline phosphatase level suggesting an occult malignancy in 7, and unexplained anemia in 3. Four patients had a neurologic syndrome; 2 had diplopia and 2 acute weakness of one arm. Claudication was the chief complaint of 4 patients, involving the leg in 1, the arm in 1, and the jaw in 2. All patients responded well to steroid therapy.