Polymyalgia Arteritica with Bilateral Subclavian Artery Occlusive Disease

Giant cell arteritis presenting as subclavian artery occlusion. A report of two cases

“…The distribution of the arteritis is similar as is the histology, giant cells occurring in the early stages of Takiyashu's disease (Judge et al, 1962) and not being a feature of long standing giant cell arteritis (Fauchald, Rygvold and Oystese, 1972). In giant cell arteritis overall, however, unlike Takiyashu's disease, there is only a minor predominance of women; of 613 cases from the literature, 254 were male and 359 female (Alestig and Barr, 1963;Bruk, 1967;Cardell and Hanley, 1951;Cook et al, 1946;Gilmour, 1941;Hamilton et al, 1971;Landberg, 1964, 1965;Hamrin, Jonsson and Hellsten, 1968;Harrison and Bevan, 1967;Hunder and Sheps, 1967;Jennings, 1938;Paulley and Hughes, 1960;Pollock et al, 1973;Reid, 1957;Rolland et al, 1973: Thompson et al, 1971 and this difference can be largely accounted for by the sex ratios in the older age groups. However, of fifteen cases where the subclavian arteries were definitely involved clinically (Alestig and Barr, 1963;Bruk, 1967;Hamilton et al, 1971;Hamrin et al, 1968;Jennings, 1938;Paulley and Hughes, 1960;Pollock et al, 1973;Reid, 1957;Rolland et al, 1973;Thompson et al, 1971), only two were male, the difference in sex ratio being significant (P < 005 >0 02).…”

“…In aortic arch syndrome secondary to giant cell arteritis it seems therefore justifiable to treat with an adequate dose of corticosteroid alone, using immediate surgery only if the ischaemia is threatening life or limb. However, subclavian obstruction from giant cell arteritis has been successfully treated by disobliteration and corticosteroids combined (Thompson et al, 1971;Hamilton et al, 1971) and this would seem appropriate if the ischaemia is severe or not improving within about 7 months.…”

“…Involvement of the subclavian vessels is commonly found at post-mortem: for example, in sixteen post-mortem examinations of patients with giant cell arteritis, there was subclavian involvement in nine (Cardell et al, 1968). Although reported (Pollock, Blennerhassett and Clarke, 1973;Rolland et al, 1973;Thompson, Simmons and Smith, 1971;Hamilton, Shelley and Tumulty, 1971), ischaemic symptoms from such involvement are said to be rare (Meadows, 1966) and it is therefore considered that two patients who presented with intermittent claudication of the arms would be of interest.…”

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

“…Le diagnostic de localisation artérielle inflammatoire périphéri-que est souvent tardif au cours de la maladie de Horton, en raison de l'absence de spécificité des signes cliniques. Dans notre revue de la littérature, nous avons observé que les manifestations cliniques révélatrices d'une artérite inflammatoire de Horton étaient représentées, en règle générale, par une claudication intermittente d'un membre (68,6 %), une ischémie d'un membre (17,9 %) ou encore une gangrène d'un membre/orteil/doigt (6,4 %) (tableau II) [16,17,21,[24][25][26][27][28][29][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][82][83][84][85][86][87][88][89][90][91][92][93]. Dans un travail récent, les manifestations cliniques révélatrices des atteintes artérielles des membres supérieurs et/ou inférieurs étaient principalement : une claudication intermittente d'un membre, une diminution/abolition d'un pouls périphérique ; les complications ischémiques (troubles trophiques, ulcères) n'étaient pas rares puisqu'elles étaient relevées dans 27,4 % des cas [12].…”

Large artery giant cell arteritis: A diagnosis to remember

“…The complete blood count, creatinine, aspartate aminotransferase, bilirubin, electrolytes and complement levels (C3 and C4) were normal; cryoglobulins and antibodies against nuclear antigens and phospholipids were absent as well as anti-neutrophil cytoplasmic antibodies. Arterial involvement occurs in 6-13% of Beh~et's patients (2,4,6,7), usually at 3 to 10 years after the onset of the disease, and the mortality in this group is high (60%) (1,2,8). 1).…”