musculoskeletal and connective tissue disorders
Giant Cell Arteritis
Symptoms and Signs of Giant Cell Arteritis
Symptoms of giant cell arteritis may begin gradually over several weeks or abruptly. Patients may present with systemic symptoms such as fever (usually low-grade), fatigue, malaise, unexplained weight loss, and sweats. Some patients are initially diagnosed as having fever of unknown origin. Eventually, most patients develop symptoms related to the affected arteries. Severe, sometimes throbbing headache (temporal, occipital, frontal, or diffuse) is the most common symptom. It may be accompanied by scalp pain elicited by touching the scalp or combing the hair. Visual disturbances include diplopia, scotomas, ptosis, blurred vision, and loss of vision (which is an ominous sign). Brief periods of partial or complete vision loss (amaurosis fugax) in one eye may be rapidly followed by permanent irreversible loss of vision. If untreated, the other eye may also be affected. However, complete bilateral blindness is uncommon. Vision loss is caused by arteritis of branches of the ophthalmic artery or posterior ciliary arteries, which leads to ischemia of the optic nerve. Funduscopic findings may include ischemic optic neuritis with pallor and edema of the optic disk, scattered cotton-wool patches, and small hemorrhages. Later, the optic nerve atrophies. Rarely, central blindness results from infarction in the occipital cortex caused by arterial lesions in the distal cervical region or base of the brain. The incidence of visual disturbances has declined over the past 5 decades, likely because giant cell arteritis is recognized and treated before visual disturbances develop. Intermittent claudication (ischemic muscle pain) may occur in jaw muscles and muscles of the tongue or extremities. Jaw claudication is noted especially when firm foods are chewed. Jaw claudication and diplopia are associated with a higher risk of blindness. Neurologic manifestations, such as strokes and transient ischemic attacks, can result when the carotid or vertebrobasilar arteries or branches are narrowed or occluded. Thoracic aortic aneurysms and dissection of the aorta are serious, often late complications of aortitis and may progress in the absence of other symptoms. 