Temporal arteritis: A case series from south India and an update of the Indian scenario

Abstract

Objective:To study the clinical, pathological and prognostic profile of patients with temporal arteritis in India.Materials and Methods:The study was conducted in a tertiary care center from south India from 2005 to 2010 in the departments of neurology and medicine. The details of all patients that satisfied the ACR 1990 criteria for diagnosis of temporal arteritis were reviewed. The clinical presentation, laboratory parameters and biopsy findings of the patients were analyzed and compared with other studies from India done over the last decade.Results:A total of 15 patients were diagnosed with temporal arteritis. The male:female ratio was 1.5:1. The mean age of onset was 67.58 years. Mean time for detection after onset of symptoms was 2.56 months. Typical manifestations included headache (100%), temporal artery tenderness (100%), jaw claudication (20%), polymyalgia rheumatica (53%) and visual manifestations (20%). The erythrocyte sedimentation rate was elevated in all patients. Biopsy was done in 13 patients, with 11 of them being positive. All patients responded to steroids well, with most patients being symptom-free within the first 48 h of treatment.Conclusions:Temporal arteritis seems to be underdiagnosed in India, with all patients previously misdiagnosed, and with a mean time from symptom onset to diagnosis of 2.5 months. The clinical presentation of temporal arteritis in India appears to be similar to that of the West, with no gender preference and a slightly younger age group.

Giant cell arteritis

“…GCA is far more common among Caucasians than other races; however, it is reported among non-Caucasians all over the world, e.g., from China[ 7 8 9 10 ], Taiwan[ 11 ], Korea[ 12 ], Japan[ 13 ], Thailand[ 14 15 ], Malaysia[ 16 ], Israel[ 17 ], Arabs[ 18 ], Mexicans[ 19 ], African American[ 20 21 ], and Alaskan Natives. [ 22 ] There are several reports of variable numbers of patients of GCA from India, including from the Punjab[ 23 24 25 26 ], New Delhi[ 27 ], Mumbai[ 28 ], Goa[ 29 ], South India[ 30 31 32 33 34 35 ], and Assam. [ 36 ] I am from Punjab originally, and I developed GCA in 2011, and two of my siblings also developed it at other times.…”

Pyrexia of Unknown Origin- An elusive diagnosis

“…The most typical manifestations of GCA include headache, temporal artery tenderness, jaw claudication, visual disturbances and Polymyalgia rheumatica. In a study by Gonzalez-Gay et al headache is seen in 87% of the patients with GCA, whereas, 100% cases of GCA presented with headache in a study conducted in south India [4,5].…”

Diagnosis and management of giant cell arteritis: an Asia‐Pacific perspective

“…Therefore, there is also little information on the clinical picture of GCA in Asian countries, although a number of relatively small case series have been reported from Japan, China and India . These reports are summarized in Table , and are compared to Australian Caucasian GCA patients .…”