Review of Giant cell arteritis

Chacko, Joseph G.; Chacko, J. Anthony; Salter, Michael W.

doi:10.1016/j.sjopt.2014.10.001

Cited by 45 publications

(51 citation statements)

References 23 publications

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“…7 20% cases of GCA are occult and are characterised by absence of systemic features. 6 The characteristic clinical sign of a tense, tender, inflamed, nodular and non pulsatile temporal artery may be absent in a small proportion of cases and a vigilant approach must be exercised to circumvent a missed diagnosis. 8 The aetiology of Central Retinal Artery Occlusion (CRAO) may be multifactorial.…”

Section: Discussionmentioning

confidence: 99%

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Central Retinal Artery Occlusion as the Initial Manifestation of Occult Giant Cell Arteritis - A Diagnostic Enigma

Vallinayagam¹

2019

DJO

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Giant cell arteritis (GCA) is a systemic vasculitis with a myriad of ocular manifestations such as Anterior Ischaemic Optic Neuropathy (AION), Central Retinal Artery Occlusion (CRAO), choroidal infarction, occipital lobe infarction and ocular motor nerve palsies. The predominant systemic features include fever, polymyalgia rheumatica, jaw claudication, weight loss and fatigue. Occult GCA accounts for a minority of cases presenting without systemic symptoms. It is a potential cause of bilateral blindness unless a high index of suspicion is contemplated. A 60 year old female presented with CRAO with no systemic symptoms of GCA. Cardiovascular examination, electrocardiography, echocardiography and carotid doppler were unremarkable. Erythrocyte Sedimentation Rate (ESR), C Reactive Protein (CRP) and platelets were normal. Bilateral prominent temporal arteries were noted but were non tender with subtle pulsations, leading to a suspicion of GCA. Temporal artery biopsy disclosed transmural granulomatous inflammation and fragmentation of internal elastic lamina, ascertaining the diagnosis. Systemic steroids were administered promptly. Although an unusual etiology of CRAO, GCA must be ruled out with utmost priority in patients older than 50 years. The diagnosis can be elusive in occult GCA and CRAO may be the inceptive manifestation, further compounding the diagnostic enigma. Urgent temporal artery biopsy is warranted in occult cases of GCA and substantiates the diagnosis in dubious cases. Occult GCA constitutes an ophthalmic emergency and the imperativeness of urgent systemic steroid therapy to prevent visual loss in the other eye cannot be overemphasized.

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Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] Occult Giant Cell Arteritis occurs in 20% cases and is defined as ocular involvement in the absence of systemic features. 6 This poses a diagnostic dilemma and multiplies the risk of blindness due to ocular complications. Temporal artery biopsy is the gold standard for diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Central Retinal Artery Occlusion as the Initial Manifestation of Occult Giant Cell Arteritis - A Diagnostic Enigma

Vallinayagam¹

2019

DJO

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“…GCA affects aorta, mainly the thoracic segment, and its extracranial branches including the external carotid, the ophthalmic, vertebral, distal subclavian, axillary, and rarely lower limb arteries. Rarely the inflammation of intracranial arteries occurs …”

Section: Introductionmentioning

confidence: 99%

Mast cells and primary systemic vasculitides

et al. 2018

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Vasculitides are characterized by inflammation and necrosis of blood vessels leading to vessel occlusion and ischemic damages of tissues. Among the inflammatory cells involved in vasculitides, neutrophils, T cells, and macrophages have been identified as the predominant cell type. This review article is focused on the role of mast cells in these chronic inflammatory processes. Mast cells are characterized by their complex plasticity. Increasing evidences document that mast cells exert both pro- and anti-inflammatory functions depending on the cell types and the microenvironment they reside in. In this context, mast cell mediators able to modulate progression of vasculitides at different levels and the anatomic localization of mast cells in different vasculitides will be described. Finally, therapeutic approach including inhibition of recruitment of mast cells to the inflammatory infiltrate and blockade of their proinflammatory effects and proangiogenic functions as potential new targets for the treatment of these diseases will be discussed.

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“…If left untreated, 15%‐20% of patients experience vision loss; however, the rate of vision loss can be reduced to 1% with glucocorticoid treatment . Moreover, patients with visual symptoms due to GCA may lose sight in the other eye within days if left untreated . These findings underscore the importance of early diagnosis as well as urgent and adequate glucocorticoid therapy.…”

mentioning

confidence: 99%