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Arm claudication due to giant cell arteritis

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. A 73yearold woman was referred to our department with a 2month history of slight fever. Two weeks ago, she developed a fever of 38°C and right upper arm pain. Her right upper arm pain was induced by exertion, such as cooking and carrying heavy loads. She lost 3 kg (from 41 to 38 kg) of body weight in 2 months. Physical examination revealed a temperature of 37.9°C. Visual and palpatory examinations of the right upper extremity were unremarkable. The Roos test was positive in the right upper limb. This test is known to be positive in thoracic outlet syndrome, but it is also positive in vascular stenosis of the upper extremities. The erythrocyte sedimentation rate was 83 mm/ hour. 18FFluorodeoxyglucose positron emission tomography/CT scan showed hyperaccumulation in the ascending aorta, iliac artery and both subclavian arteries (figure 1), but not in the carotid arteries. Giant cell arteritis (GCA) of the largevessel type was diagnosed. Symptoms improved with oral administration of prednisolone (30 mg/day). GCA is the most common form of vasculitis in older adults, affecting people over 50 years of age. GCA is classified into two types according to the vessel involved: cranial GCA, which involves the temporal artery, and largevessel GCA, which involves the extratemporal artery. The affected vessels of the latter, the subclavian artery (83%) and axillary artery (60%), are the most common, and the frequency of arm claudication is also high (52%). Largevessel vasculitis should be considered in cases of unexplained fever with arm claudication.