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Giant-cell arteritis

Giant-cell arteritis is designated also as temporal or cranial arteritis. It represents granulematozny arteritis of separate segments of an aorta and the main arteries — most often departing from an aortic arch. Though at patients can be observed and widespread vascular defeats, nevertheless are usually involved in process mainly arteries of average caliber in the head and a neck, and damage of temporal arteries (branches of a carotid artery) from where there was one of names of a disease — temporal arteritis is clinically often expressed. Giant-cell arteritis usually occurs at persons 50 years are more senior and are more often at women, than at men; about a half of patients with this disease have clinical manifestations of a rheumatic polimialgiya.

In development of giant-cell arteritis the large role is played by hereditary factors, in particular, the increased frequency of giant-cell arteritis at relatives of patients with this disease is noted. It is reported about communication of GKA with a carriage of antigens of the HLA — DR4 and DRB1 system.

Pathomorphologically the disease represents a panarteritis from an infiltratsiy vascular wall of a mononuklearama and with frequent formation of colossal cells. There is a proliferation of an intima and destruction of an internal elastic plate. These changes are most often observed in a superficial temporal artery, in vertebral arteries, a. oftalmica and its back tsiliarny branch. Similar changes can be found also in other vascular areas, but mainly — in the aorta and its branches departing from an arch.

Clinical picture of giant-cell arteritis

At sick GKA headaches of the pulsing character in temporal area, sometimes in a nape, weakness are observed, it is frequent — subfebrile condition. At part of patients fever with high figures of temperature can be observed, but the leukocytosis usually does not happen. Patients complain of pains when chewing — "the alternating lameness" of masseters, difficulties during the swallowing, pain in a neck. The affected temporal arteries and arteries of a neck look knotty, expanded; are painful at a palpation; their pulsation can be absent. Sometimes the listed vessels are externally not changed.

The diplopia, ptosis, passing or permanent loss of sight are often observed (it can be partial or full). In the absence of treatment almost at a half of patients irreversible loss of sight is observed. Oftalmoskopicheski notes edematous pale disks of optic nerves, hemorrhages, "cotton wool flakes" on an eyeground; later there is an atrophy of optic nerves.

At damage of an aorta (that occurs at 15% of patients) the aortic arch syndrome is observed: the expressed asymmetry of pulse, emergence of systolic noise in carotid, subclavial arteries, "the alternating lameness" of upper extremities, Reynaud's syndrome; noise of aortal regurgitation can be listened. The risk of development of aneurism of chest department of an aorta, stratification of an aorta is very big. These complications are more often observed in late terms — in 5 — 7 from the beginning of a disease.

SOE is considerably accelerated, there is normokhromny or hypochromia anemia. The IgG level and a complement can be increased.

Almost at a half of patients with GKA the rheumatic polimialgiya is observed. The rheumatic polimialgiya is shown by pains and constraint in muscles of a shoulder girdle, a waist and a basin, the subfebrile temperature, weight loss is quite often observed. Patients experience difficulty when combing hair, clothing, a rising from a chair etc. There can be muscle pains at night.

Treatment of giant-cell arteritis

Treatment of giant-cell arteritis consists in purpose of Prednisolonum in a dose of 1 — 2 mg/kg a day within 1 — 2 month (before remission) with the subsequent gradual dose decline. At inefficiency of corticosteroids apply cytostatics (methotrexate). It is necessary to appoint glucocorticoids as soon as possible that allows to prevent sight loss. If activity of a disease keeps and palindromias are observed, continue treatment by Prednisolonum within many months and even years. Among late complications aneurism of chest department of an aorta is most often observed, stratification of an aorta is possible.

At patients with a rheumatic polimialgiya (without giant-cell arteritis) apply small doses of Prednisolonum (10-20 mg/days) — usually positive effect comes within several days, however treatment is continued in individually picked up maintenance doses it is long — of half a year till two years and more as at Prednisolonum cancellation usually there comes recurrence of a disease.

 
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