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FRI0150 Clinical manifestations of giant cell arteritis: changes over 20 years
  1. KT Calamia1,
  2. JR Basarich2,
  3. M Schirmer3,
  4. MD Cohen1
  1. 1Rheumatology, Mayo Clinic, Jacksonville, USA
  2. 2Medical Student, Medical College of Wisconsin, Milwaukee, USA
  3. 3Internal Medicine, Innsbruck University, Innsbruck, Austria

Abstract

Background Complications of Giant Cell Arteritis (GCA) can be prevented with prompt diagnosis and treatment in most cases. However, the presenting manifestations of the disease are diverse and may be non-specific.

Objectives We undertook this study in order to determine the clinical features in 100 conecutive patients with GCA. We compared these features in patients with and without visual loss. We compared the findings to those from a study of 100 consecutive biopsy proven cases from the same institution by one of the authors (KTC) 20 years earlier.

Methods We reviewed the clinical records of 100 consecutive biopsy-proven cases of GCA diagnosed just prior to December 31, 1998. Findings in patients with and without visual loss were compared and findings in this series were compared to those of an identical review of 100 consecutive biopsy-proven cases from our institution, ending in December, 1978.1 Differences were compared using Fisher’s exact test and the rank sum test.

Results In the current series, there were 77 females and 23 males, with a mean age at diagnosis of 73.2 years. The mean duration of symptoms prior to diagnosis was 3.5 months. Headache was the initial symptom in 41 patients and twenty patients presented with polymyalgia rheumatica. However, systemic symptoms dominated the clinical presentation in 22 patients and 13 patients were evaluated for fever of unknown origin. Swallowing or tongue claudication was seen in 7 patients. Trismus or dysgeusia were reported by some patients. Nine patients complained of sore throat and 10 patients had cough. Twelve patients developed loss of vision. Inflammatory parameters were not significantly different in patients with visual loss as compared to those without. The median duration of symptoms were shorter (p < 0.001), median sedimentation rate was lower (p < 0.001) and the median haemoglobin concentration was higher (p = 0.011) in the current series when compared to patients diagnosed 20 years earlier.

Conclusion The presenting manifestations in this group of patients with GCA were diverse and often did not suggest the diagnosis. Clinical suspicion for the disease in the setting of an older patient with systemic symptoms or with a variety of head and neck symptoms, with laboratory evidence of an inflammatory process, was critical for the diagnosis. Because of this suspicion, patients were diagnosed earlier after onset of symptoms, with less prominent inflammatory findings, than they were 20 years ago.

Reference

  1. Calamia KT, Hunder GG. Clinical manifestations of giant cell (temporal) arteritis. Clin Rheum Dis. 1980;6:389–403

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