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Gomes de Pinho Q, Daumas A, Benyamine A, Bertolino J, Rossi P, Schleinitz N, Harlé JR, Jarrot PA, Kaplanski G, Berbis J, Granel B. Pericardial effusion in giant cell arteritis is associated with increased inflammatory markers: a retrospective cohort study. Rheumatol Int 2022; 42:2013-2018. [PMID: 35525874 DOI: 10.1007/s00296-022-05137-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/16/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Giant cell arteritis (GCA) is the most frequent vasculitis affecting adults aged > 50 years. Cardiac involvement in GCA is considered rare, and only a few cases of pericarditis have been reported. The aim of this study was to determine the characteristics and prognosis of GCA patients suffering from pericardial involvement at diagnosis. METHODS We conducted a single-centre, retrospective chart review of patients with GCA in internal medicine departments (from 2000 to 2020). Patients were identified through a centralized hospital database. We retrospectively collected demographic, clinicobiological, histological, imaging, treatment and outcome data. Patients with pericardial effusion, defined as an effusion visible on the CT-scan performed at GCA diagnosis were compared to those without pericardial involvement. RESULTS Among the 250 patients with GCA, 23 patients (9.2%) had pericardial effusion on CT-scan. The comparison between the groups revealed similar distribution of age, gender, cranial symptoms and ocular ischaemic complications. Patients with pericardial effusion had a higher frequency of weight loss. They also had lower haemoglobin levels and higher platelet levels (p = 0.006 and p = 0.002, respectively), and they more frequently had positive temporal artery biopsy. There were no differences concerning the treatment, relapses, follow-up duration or deaths. CONCLUSIONS This case series sheds light on GCA as a cause of unexplained pericardial effusion or symptomatic pericarditis among adults aged > 50 years and elevated inflammatory biological markers. Fortunately, pericardial involvement is a benign GCA manifestation. In that context, the search for constitutional symptoms, cranial symptoms and associated signs of polymyalgia rheumatica is crucial for rapidly guiding GCA diagnosis.
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Affiliation(s)
- Quentin Gomes de Pinho
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France.
| | - Aurélie Daumas
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Timone, Service de Médecine Interne, Gériatrie et Thérapeutique, Aix-Marseille Université (AMU), Marseille, France
| | - Audrey Benyamine
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Julien Bertolino
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Pascal Rossi
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Nicolas Schleinitz
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Timone, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Jean-Robert Harlé
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Timone, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Pierre André Jarrot
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique, Aix-Marseille Université (AMU), Marseille, France
| | - Gilles Kaplanski
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique, Aix-Marseille Université (AMU), Marseille, France
| | - Julie Berbis
- Faculté de Médecine de la Timone, Laboratoire de Santé Publique, EA 3279, Centre d'étude et de Recherche sur les Service de Santé et la Qualité de vie, Aix-Marseille Université (AMU), Marseille, France
| | - Brigitte Granel
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
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Lim ZS, Sharp C. Neck swelling and airway narrowing as an initial manifestation of giant cell arteritis. BMJ Case Rep 2021; 14:14/3/e237743. [PMID: 33722908 PMCID: PMC7959238 DOI: 10.1136/bcr-2020-237743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Giant cell arteritis can result in a wide range of symptoms due to the extensive distribution of the external carotid artery. Face and neck swelling and trismus are under-recognised features of giant cell arteritis and can present as the initial symptom prior to the development of classical temporal tenderness and jaw claudication. The lack of awareness of the less common symptoms may result in a late diagnosis of giant cell arteritis, leading to irreversible vision loss. In this paper, we present a case of neck swelling and airway narrowing as the initial manifestation of giant cell arteritis.
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Affiliation(s)
- Zhen Sheng Lim
- Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Colin Sharp
- Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
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Glassy CM, Guggenheim C. Giant cell arteritis of the thyroid in a 69-year-old male. Mod Rheumatol 2012; 23:1242-4. [PMID: 22961124 DOI: 10.1007/s10165-012-0743-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
Abstract
We report the case of a 69-year-old Caucasian male with a histological confirmed diagnosis of giant cell arteritis (GCA) of the thyroid. To our knowledge this is the second reported case of GCA of the thyroid with a histological confirmed diagnosis. Unique to this case is that our patient did not have the simultaneous occurrence of a positive temporal artery biopsy or classic symptoms of temporal arteritis. The patient presented with fever of unknown origin, and fatigue. Laboratory reports included a sedimentation rate of >100 mm/h and C-reactive protein level of 17.1 mg/dL. Goiter with irregular calcifications was found on the computed tomography image. Temporal artery biopsy was negative. The patient continued to have intermittent fever after discharge and was readmitted to the hospital 41 days after discharge for fever and increasing fatigue. The thyroid was resected to rule out neoplasia. Granulomatous GCA was identified within the thyroid specimen.
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Affiliation(s)
- Crystal M Glassy
- Department of Family Medicine, University of California, Irvine, 101 The City Blvd South, Bldg 200 Suite 835, Orange, CA, 92868, USA,
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Liozon E, Petit B, Ouattara B, Rhaïem K, Galinat S, Vidal E. [Multinodular goitre with widespread vasculitis of thyroid arteries revealing temporal giant cell arteritis]. Rev Med Interne 2007; 28:885-7. [PMID: 17629594 DOI: 10.1016/j.revmed.2007.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
Abstract
We describe a 62-year-old woman with slowly growing usual nodular goitre in whom diffuse giant cell arteritis (GCA) of the thyroid arteries was found upon thyroidectomy, revealing otherwise unsuspected biopsy-proven temporal arteritis. To our knowledge, this association had been previously reported in only three instances. In each case, GCA of the thyroid arteries appeared clinically silent, did not produce significant glandular dysfunction, and was uncovered thanks to a planned thyroidectomy for nodular goitre. These observations highlight that thyroid artery involvement by GCA, even widespread, as in our patient, may be overlooked clinically and may produce little or no thyroid dysfunction.
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Affiliation(s)
- E Liozon
- Service de médecine interne A, hôpital universitaire Dupuytren, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges cedex, France.
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