Presentation of occult giant cell arteritis

Area of Science:

• Rheumatology
• Internal Medicine
• Neurology

Background:

• Giant cell arteritis (GCA) classically presents with headache, visual disturbances, and polymyalgia rheumatica.
• However, non-classic presentations of GCA are not uncommon.
• Early diagnosis and treatment are vital to prevent irreversible complications.

Purpose of the Study:

• To investigate the spectrum of presenting symptoms in biopsy-proven giant cell arteritis.
• To highlight less common initial complaints in patients with GCA.
• To emphasize the importance of considering GCA in patients with unexplained symptoms.

Main Methods:

• Retrospective review of 74 patients with biopsy-proven giant cell arteritis.
• Analysis of presenting complaints in patients whose primary symptom was not a cardinal GCA manifestation.
• Categorization of non-classic symptoms including fever, constitutional symptoms, neurological deficits, and claudication.

Main Results:

• 30 out of 74 patients (40.5%) presented with non-classic symptoms as their predominant complaint.
• Fever was the main issue in 12 patients.
• Other significant presentations included anorexia, weight loss, elevated alkaline phosphatase, anemia, neurological syndromes (diplopia, weakness), and claudication (jaw, arm, leg).

Conclusions:

• Giant cell arteritis can manifest with a wide range of symptoms beyond the classic triad.
• Fever, constitutional symptoms, neurological issues, and claudication can be the primary presenting problems in GCA.
• Prompt recognition of these varied presentations and initiation of steroid therapy are essential for successful management.