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Giant-cell arteritis


Giant-cell arteritis (temporal, Horton's disease) - the system granulematozny vasculitis with preferential damage of extra-and intracranial arteries arising at persons is more senior than 50 years. It is often combined with a rheumatic polimialgiya, the last is considered as one of displays of giant-cell arteritis.

Symptoms of Giant-cell arteritis:

Distinguish the following clinical options of giant-cell arteritis:
Rheumatic polimialgiya.
Combination of local (temporal) arteritis and rheumatic polimialgiya.
Giant-cell arteritis with damage of large arteries (sleepy, subclavial, vertebral) and aortas.
Fever without signs of defeat of cranial vessels and muscles.

Main clinical displays of giant-cell arteritis: fever, headache, muscle pains. Fever is usually febrile, especially painful at night, is followed by pouring sweats. Almost all patients note sharp weakness, loss of body weight, anorexia.

Vascular manifestations depend on localization of the affected artery.

At damage of a temporal artery (90-100% of cases) the constant intensive headache (both unilateral, and bilateral) amplifying at a touch to head skin is characteristic. Temporal arteries are thickened, edematous, painful at a palpation. Morbidity sometimes happens so expressed that the patient cannot brush the hair or lay down on a pillow. The pulsation of arteries is weakened.

At damage of a maxillary artery (4-67% of cases) of pain and numbness is observed in the field of masseters. Patients are disturbed by a causeless dentagra.

Damage of an occipital artery is followed by headaches in occipital area.

Damage of a lingual artery is shown by very unusual symptom of "the alternating language lameness" (at a conversation there are pains and numbness demanding rest - similarly alternating lameness of extremities).

Damage of arteries, krovosnabzhayushchy eyes and eye muscles, is shown by an ischemic neuropathy of an optic nerve, an ophthalmoplegia, a diplopia, loss of sight as a result of occlusion of the central artery of a retina, an ischemic chorioretinitis, an iritis, conjunctivitis, an episcleritis, a sclerite.

Damage of an aorta and its branches in the form of an aortitis, insufficiency of the aortal valve, a koronariit with development of a myocardial infarction, an aortic aneurysm with danger of stratification is described. Aneurism of chest department of an aorta arises at giant-cell arteritis 17,4 times more often, and belly department - by 2,4 times more often than in the general population.

Defeat of a nervous system:

Defeat of a nervous system can be presented by mononeurites, a polyneuropathy. Strokes arise as a result of damage of arteries of a brain.

Defeat of cardiovascular system:

Defeat of cardiovascular system - a myocardial infarction, the stratifying aortic aneurysm.

Rheumatic polimialgiya:

The rheumatic polimialgiya is combined with giant-cell arteritis in 30% of cases and characterized by the expressed bilateral symmetric pains and constraint in muscles of a shoulder and pelvic girdle. Strengthening of an oxycinesia and easing at rest is characteristic.

Гистологическая картина гигантоклеточного артериита

Histologic picture of giant-cell arteritis

Reasons of Giant-cell arteritis:

The etiology is unknown. Coincidence of peaks of incidence of giant-cell arteritis and a rheumatic polimialgiya to peaks of the infectious diseases caused by Mycoplasma pneumoniae, Parvovirus B19, Chlamydia pneumoniae is revealed.

Communication of giant-cell arteritis with a carriage of Ag of HLA-DR4 and with HLA-DRB104 alleles is tracked.

Treatment of Giant-cell arteritis:

The most effective drugs for treatment of giant-cell arteritis - glucocorticoids. At an uncomplicated current the initial dose of Prednisolonum makes 30-40 mg/days. At damage of large arteries the dose should be raised to 40 mg/days, and at a vision disorder - to 40-60 mg/days. The dose of drug begins to be reduced at achievement of clinical laboratory remission that usually occurs in 4-6 weeks after an initiation of treatment. The maintenance dose makes 5-10 mg, treatment duration - not less than 2 years. Criterion of an exacerbation of a disease consider increase in SOE and resuming of headaches. The intermittent scheme of treatment at giant-cell arteritis is not used. Unexpectedly high was a percent of the patients needing long glucocorticoid therapy. At these patients in half of cases serious complications of long glucocorticoid therapy (arterial hypertension, fractures of bones, a diabetes mellitus) develop. In certain cases recommend to include cytostatics (Azathioprinum of 100-150 mg/days or a methotrexate of 7,5 mg/week) in the scheme of treatment that allows to lower a glucocorticoid dose.

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