Atteintes artérielles des membres supérieurs et inférieurs au cours de la maladie de Horton

Assié, C.; Marie, I.

doi:10.1016/j.lpm.2010.11.005

“…3 The most common symptom of such involvement is arm claudication and pain (68%), but in rare cases it can evolve into critical ischemia, digital ulceration and gangrene. 1 Unlike for temporal artery GCA, there are no validated independent criteria for the diagnosis of GCA with involvement of the upper limb arteries, so this relies on clinical suspicion, supported by laboratory and imaging studies. An ESR of over 50 mm/h was one of the first inflammatory markers associated with the disease, and is part of the American College of Rheumatology criteria for GCA diagnosis (86.5% sensitivity and 47.7% specificity).…”

Section: Discussionmentioning

confidence: 99%

“…4 Some studies of GCA with upper or lower limb involvement found lower ESR values compared with temporal artery GCA. 1 CRP level was observed to be a more sensitive marker of disease activity, and is especially useful to access disease relapse. 2 The European League Against Rheumatism guidelines for the management of GCA recommend a temporal artery biopsy in all patients whenever a diagnosis is suspected (level of evidence 3, strength of recommendation C).…”

Section: Discussionmentioning

confidence: 99%

Acute upper limb ischemia, a rare presentation of giant cell arteritis

Almeida-Morais

¹

,

Galego

²

,

Pack

³

et al. 2016

Revista Portuguesa de Cardiologia

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Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10---15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis.We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure.The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers.GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization. 2174-2049Document downloaded from http://www.elsevier.es, day 15/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 15/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 237.e2L. Almeida-Morais et al. PALAVRAS-CHAVEArterite de células gigantes; Isquemia crítica dos membros superiores; Bypass carótido-umeral Isquemia crítica dos membros superiores, uma apresentação rara de arterite de células gigantes Resumo A arterite de células gigantes (ACG) é uma vasculite de grandes vasos, com envolvimento extracraniano em 10-15% dos casos, afetando preferencialmente a aorta e os seus ramos. Os aneurismas da aorta ascendente são mais frequentes em doentes com ACG, mas são raros no momento do diagnóstico.Apresentamos o caso de uma doente, caucasiana, com 80 anos de idade, que descrevia dor muscular nos membros superiores, com rigidez matinal dos ombros, desde há oito meses. Nos últimos dois meses referia claudicação intermitente de agravamento progressivo, dor intensa, extremidades frias e o aparecimento de úlceras digitais. Ao exame objetivo não se palpavam pulsos radiais ou cubitais, nem se registavam valores de pressão arterial.Laboratorialmente, destacava-se anemia normocíticanormocrómica, VS de 120 mm/h e ...

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“…In 10---15% of patients there is involvement of aortic arch branches, particularly the subclavian and axillary arteries. 1,2 This involvement is rarely the presenting feature of the disease, usually resulting from progression or relapse after discontinuation or tapering of corticosteroid therapy. 1 One study reported a period of eleven months between diagnosis of temporal artery GCA and the appearance of symptoms resulting from involvement of the upper limb arteries.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 This involvement is rarely the presenting feature of the disease, usually resulting from progression or relapse after discontinuation or tapering of corticosteroid therapy. 1 One study reported a period of eleven months between diagnosis of temporal artery GCA and the appearance of symptoms resulting from involvement of the upper limb arteries. 3 The most common symptom of such involvement is arm claudication and pain (68%), but in rare cases it can evolve into critical ischemia, digital ulceration and gangrene.…”

Section: Discussionmentioning

confidence: 99%

Acute upper limb ischemia, a rare presentation of giant cell arteritis

Almeida-Morais

¹

,

Galego

²

,

Pack

³

et al. 2016

Revista Portuguesa de Cardiologia (English Edition)

View full text Add to dashboard Cite

Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10---15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis.We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure.The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers.GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization. 2174-2049Document downloaded from http://www.elsevier.es, day 15/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 15/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 237.e2L. Almeida-Morais et al. PALAVRAS-CHAVEArterite de células gigantes; Isquemia crítica dos membros superiores; Bypass carótido-umeral Isquemia crítica dos membros superiores, uma apresentação rara de arterite de células gigantes Resumo A arterite de células gigantes (ACG) é uma vasculite de grandes vasos, com envolvimento extracraniano em 10-15% dos casos, afetando preferencialmente a aorta e os seus ramos. Os aneurismas da aorta ascendente são mais frequentes em doentes com ACG, mas são raros no momento do diagnóstico.Apresentamos o caso de uma doente, caucasiana, com 80 anos de idade, que descrevia dor muscular nos membros superiores, com rigidez matinal dos ombros, desde há oito meses. Nos últimos dois meses referia claudicação intermitente de agravamento progressivo, dor intensa, extremidades frias e o aparecimento de úlceras digitais. Ao exame objetivo não se palpavam pulsos radiais ou cubitais, nem se registavam valores de pressão arterial.Laboratorialmente, destacava-se anemia normocíticanormocrómica, VS de 120 mm/h e ...

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