The Diagnosis and Treatment of Giant Cell Arteritis.
Autor: | Ness, Thomas, Bley, Thorsten A., Schmidt, Wolfgang A., Lamprecht, Peter |
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Předmět: |
HORMONE therapy
ASPIRIN METHOTREXATE GIANT cell arteritis diagnosis AZATHIOPRINE ADRENOCORTICAL hormones BIOPSY BLOOD sedimentation C-reactive protein DIFFERENTIAL diagnosis DUPLEX ultrasonography GIANT cell arteritis INFLAMMATION MAGNETIC resonance imaging MEDICAL protocols MEDICAL societies MEDLINE OCULAR manifestations of general diseases ONLINE information services POLYMYALGIA rheumatica POSITRON emission tomography CONTINUING medical education SYSTEMATIC reviews EVIDENCE-based medicine CONTINUING education units TEMPORAL arteries DISEASE complications SYMPTOMS DIAGNOSIS THERAPEUTICS |
Zdroj: | Deutsches Ärzteblatt International; 5/23/2013, Vol. 110 Issue 21, p376-386, 12p |
Abstrakt: | Background: Giant cell arteritis (GCA) is the most common systemic vasculitis in persons aged 50 and above (incidence, 3.5 per 100 000 per year). It affects cranial arteries, the aorta, and arteries elsewhere in the body, e.g., in the limbs. Methods: We selectively review the pertinent literature, including guidelines and recommendations from Germany and abroad. Results: The typical symptoms of new-onset GCA are bi - temporal headaches, jaw claudiacation, scalp tenderness, visual disturbances, systemic symptoms such as fever and weight loss, and polymyalgia. The diagnostic assessment comprises laboratory testing (erythrocyte sedimentation rate, C-reactive protein), imaging studies (duplex sonog - raphy, high-resolution magnetic resonance imaging, positron-emission tomography), and temporal artery biopsy. The standard treatment is with corticosteroids (adverse effects: diabetes mellitus, osteoporosis, cataract, arterial hypertension). A meta-analysis of three random - ized controlled trials led to a recommendation for treatment with methotrexate to lower the recurrence rate and spare steroids. Patients for whom methotrexate is contraindicated or who cannot tolerate the drug can be treated with azathioprine instead. Conclusion: Giant cell arteritis, if untreated, progresses to involve the aorta and its collateral branches, leading to various complications. Late diagnosis and treatment can have serious consequences, including irreversible loss of visual function. [ABSTRACT FROM AUTHOR] |
Databáze: | Complementary Index |
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