Giant cell arteritis

GCA said in the past that outlined called cranial arteritis, temporal arteritis, granulomatous arteritis. After the intimate understanding of the larger arteries can be any involvement, and a pathological features named Giant cell arteritis. GCA and PMR etiology of the etiology remains unclear, the incidence of family survey found that GCA and PMR patients a greater incidence relatives, the most part they are HLA-DR4 and CW3 suggest a susceptibility gene. GCA inflammatory response to intra-arterial concentration Descemet's membrane, which may be related to certain antigens on their own. Immunohistochemical study also found that the inflammation of the temporal artery layer within immunoglobulin deposition, The infiltration of inflammatory cells to TH cells. Patients with peripheral blood lymphocytes in vitro on human artery and muscle resistance original sensitive. GCA pathological changes of diffuse arteritis, and the arteries were affected. To common carotid artery bifurcation, as superficial temporal artery, vertebral artery, and ophthalmic artery after eyelashes artery, followed by the internal carotid, external carotid artery; About 10% ~ 15% as the aortic arch arteries, proximal and distal aortic involvement; and the lung, kidney, spleen artery less involved. Involvement segmental artery lesions were jumping distribution of Patchy hyperplasia distal aortic involvement; And the lung, kidney, splenic artery less involved. Involvement segmental artery lesions were jumping distribution of Patchy hyperplasia granuloma. Inflammation regional organizations biopsy showed lymphocytes, macrophages, cells and multinucleated giant cells infiltration, and a flexible membrane to the center of the whole floor arteritis can lead to vascular rupture, intimal thickening, as well as a narrow tube membrane occlusion [5, 6]. Infiltrating cells multinucleated giant cells to the most characteristic and occasionally eosinophils and neutrophils. Class fibrin deposition rare. Where diagnosis 50 years and older, there's no explanation of fever, malaise, weight loss, anemia, ESR "50mm / h; Recently there has been a headache, visual impairment (black indistinct, blurred vision, diplopia, blind); Transcranial or other signs of arterial insufficiency, If Masticator intermittent arterial obstacles, tinnitus, vertigo; PMR syndrome or that there should be other suspects and the disease, seize for further examination, such as the temporal artery angiography, temporal artery live suppository to determine the diagnosis. If the conditions were not right, the exclusion of other diseases, such as rheumatic conditions, the trial of glucocorticoid treatment. Clinical manifestations GCA incidence good for the elderly, the average age of onset of 70 years (50 ~ 90 years). Women outnumber men (2:1). GCA incidence may be unexpected, but most of the patients have been diagnosed several months before the course and clinical symptoms, as fever (low heat or fever), fatigue and weight loss. Some patients showed PMR syndrome. Arteritis involvement with the GCA symptoms is a typical example. ⑴ headache : GCA is the most common symptom, one side or both sides of the temporal, occipital forehead tension or pain, or superficial burning, tearing or paroxysmal-severe pain, pain skin redness Yan pressure tenderness, can sometimes touch the scalp nodule or nodules kind skyrocketing superficial temporal artery. ⑵ other cranial artery insufficiency symptoms : muscle chewing, swallowing and genioglossus muscle insufficiency. Typical performance of intermittent movement standstill, masticatory muscle-ache like to chew suspended (jaw claudication) and swallowing or language such as a halt. Eyelashes artery, ophthalmic artery, retinal artery, occipital cortex artery involvement, can cause blurred vision. ptosis or visual barriers. About 10% ~ 20% GCA patients unilateral or bilateral blindness, or to a sexual visual impairment, and the Montreal threatened. GCA blindness is one of the serious complications. The blind side failed to timely treatment, and often a two-week occurrence contralateral blind, About 8% ~ 15% GCA patients to permanent blindness, GCA thus confirming the diagnosis and early treatment is prevention of blindness important principle. Some patients, there will be pain in the ears, dizziness and hearing loss and other symptoms. ⑶ other artery involvement performance : About 10% ~ 15% GCA show, the lower extremity arterial insufficiency symptoms upper extremities intermittent lower limb movement disorder or intermittent claudication; carotid, subclavian artery or axillary artery involvement, vascular murmur can be heard, beating or weakening pulse (no pulse syndrome); aorta or aortic arch involvement. can lead to aortic arch layer separation, have aneurysms or dissections, needing angiography in the diagnosis. ⑷ performance of the central nervous system : GCA will have depression, impaired memory, insomnia and other symptoms.