Related articles: Giant cell arteritis
Definition
Giant cell arteritis is a form of vasculitis (inflammation of blood vessel walls). The disorder is relatively common and generally affects people over the age of 50, especially women.
Giant cell arteritis tends to affect large and medium-caliber blood vessels containing elastic tissue. For this reason, the pathological process mainly affects the aortic arch and its main branches, the carotid system and the temporal and cranial arteries.
The lesions found at the level of the affected blood vessels are characterized by infiltrates of inflammatory mediators (mononuclear cells, activated T lymphocytes and macrophages) and multinucleated giant cells (hence the name giant-cell arteritis). The intimate habit is markedly thickened, with concentric narrowing and occlusion of the lumen.
Most common symptoms and signs *
- Altered color vision
- Fleeting love
- Anemia
- Anorexia
- Asthenia
- Increase in the ESR
- blepharoptosis
- Neck pain
- Shoulder pain
- Pain associated with chewing
- Ocular pain
- Papilla edema
- Temperature
- Tingling in the head
- Headache
- Paresthesia
- Weight loss
- Narrowing of the visual field
- Reduced vision
- Stiffness in the muscles of the back and neck
- scotomas
- Night sweats
- trichodynia
- Double vision
- Blurred vision
Further indications
The symptoms of giant cell arteritis may begin abruptly or gradually over a period of several weeks.
The most frequent manifestation is a pulsating headache, sometimes severe, in the temporal, occipital, frontal or diffuse area. Headaches may be associated with tingling or pain in the scalp.
The symptomatology can also include visual disturbances (diplopia, scotomas, ptosis, visual field alterations, blurred vision, fleeting amaurosis and loss of vision), tenderness on the temporal artery on palpation and pain in the muscles of the face, especially during chewing of solid foods (jaw claudication).
Fever (generally not high), unexplained weight loss, sweating, malaise and asthenia can also occur. Furthermore, the simultaneous presence of polymyalgia rheumatica, an inflammatory syndrome characterized by stiffness and pain in the shoulders and neck, is frequent.
Possible neurological complications of giant cell arteritis, often late, include transient strokes and ischemic attacks (due to reduction in the diameter and occlusion of the carotid arteries or their branches), aneurysms and thoracic aortic dissections and myocardial infarction.
The diagnosis is clinical and is confirmed by temporal artery biopsy, an examination that shows the infiltration of inflammatory cells. Generally, ESR and C-reactive protein are elevated.
Early recognition and timely treatment of giant cell arteritis are essential, due to the high risk of blindness and stroke. In general, corticosteroids are administered at high doses. The therapy may also use immunosuppressive drugs (eg methotrexate or azathioprine) and low-dose aspirin to prevent ischemic events, unless contraindications.
