Daily Archive 30.09.2019

Temporal Giant Cell Arteritis

Temporal giant cell arteritis , cranial arteritis, temporal arteritis , Horton’s disease is a systemic lesion of arteries, mainly of muscular-elastic and muscle types.
In temporal giant cell arteritis, the vessels of the head (primarily the temporal arteries) and the thoracic aorta are most often affected. As a rule, elderly people are older than 50 years old, most often women. Several family cases of the disease are described. Temporal giant cell arteritis belongs to the group of allergic vasculitis .
The etiology is not known, possibly viral. There is a connection with respiratory infections, the content of birds (parrots) in the house, and the detection of hepatitis B surface antigen in serum.

Pathomorphology of the temporal giant cell arteritis

In areas of vascular lesions, fixed immunoglobulin M and immunoglobulin G, components of the complement of the system, are detected. The acute phase is characterized by the phenomena of mucoid swelling, fibrinoid degeneration in the intima and middle lining of the arteries with thromboangiitis obliterans, necrotic changes and the transition to sclerosis. As part of the granulation tissue, giant multinuclear cells similar to Pirogov- Langgans cells are detected .

Clinic of the temporal giant cell arteritis

The onset of the disease is most often gradual – with the appearance of pain and stiffness in the neck, shoulder girdle, malaise, nausea, loss of appetite. An acute onset is also possible – high fever , sharp headaches in the area of ​​the affected vessels, sometimes with impaired and loss of vision. A painful and throbbing temporal artery is palpated. In temporal giant cell allergy, there may be a combined lesion of the coronary and abdominal vessels.
There is a frequent combination of this disease and rheumatic polymyalgia ( Forestier – Sertonsini syndrome ), which consists in the appearance of symmetric polymyalgia in the elderly , especially in the neck muscles. shoulder girdle, and accompanied by low-grade fever, asthenia , anorexia.
In both cases, there is a sharp increase in ESR – from 50 to 100 mm / h, hyper-A2-globulinemia, hypoalbuminemia , moderate hyperchromic anemia.

Treatment of temporal giant cell arteritis

There is a pronounced effect of glucocorticosteroid therapy (differential diagnostic sign of temporal giant cell arteritis). Symptom attenuation occurs within a few days after the administration of the glucocorticosteroid drug (initial dose of 40-50 mg, followed by a decrease to a maintenance dose of 5-10 mg). Long-term use of delagil , indomethacin is indicated , for relieving pain during an attack – novocaine chipping of near-arterial tissues.