|A.||Cutaneous leukocytoclastic vasculitis|
Giant cell arteritis
Giant cell arteritis (temporal arteritis), is an inflammation of medium- and large-sized arteries. It characteristically involves one or more branches of the carotid artery, particularly the temporal artery.
occurs almost exclusively in individuals aged >50 years.
It is more common in women than in men
Polymyalgia rheumatica may be seen in 40–50% of patients with giant cell arteritis.
Histopathologically, the disease is a panarteritis with inflammatory mononuclear cell infiltrates within the vessel wall with frequent giant cell formation.
There is the proliferation of the intima and fragmentation of the internal elastic lamina. Pathophysiologic findings in organs result from the ischemia related to the involved vessels.
Clinically characterized by the complex of fever, anemia, high ESR, and headaches (may be associated with a tender, thickened, or nodular artery ).
Features of systemic inflammation – malaise, fatigue, anorexia, weight loss, sweats, arthralgias, polymyalgia rheumatica, or large-vessel disease.
Scalp pain and claudication of the jaw and tongue may occur.
A dreaded complication of giant cell arteritis is ischemic optic neuropathy, which may lead to serious visual symptoms, even sudden blindness in some patients.
The diagnosis can be confirmed by biopsy of the temporal artery
Prednisone, 40–60 mg/d for ~1 month, followed by gradual tapering.
When ocular signs and symptoms occur, consideration should be given for the use of methylprednisolone 1000 mg daily for 3 days to protect remaining vision.
Aspirin 81 mg daily has been found to reduce the occurrence of cranial ischemic complications in giant cell arteritis.
Tocilizumab (anti-IL-6 receptor)