小结
定义
病史和体格检查
关键诊断因素
- headache
- polymyalgia rheumatica symptoms
- older age
- extremity claudication
- jaw claudication
- sudden loss of vision
- arterial tenderness, thickening, or nodularity
- absent temporal artery pulse
- abnormal fundoscopy
其他诊断因素
- systemic symptoms
- neurologic symptoms
- cough, sore throat, hoarseness
- bruit on auscultation
- asymmetric blood pressure
- shoulder tenderness
- limited active range of movement of shoulders and hips
- wrist and knee swelling
- dental pain, tongue pain, or infarction of the tongue
危险因素
- age ≥50 years
- female sex
- genetic factors
- smoking
- atherosclerosis
- environmental factors
诊断性检查
首要检查
- CRP
- erythrocyte sedimentation rate (ESR)
- CBC
- LFTs
- temporal artery biopsy
- temporal artery ultrasound
需考虑的检查
- noninvasive vascular imaging
新兴检查
- 18F-fluorodeoxyglucose (FDG)-PET scan of head to mid-thigh
治疗流程
suspected giant cell arteritis
confirmed giant cell arteritis
撰稿人
专家顾问
Kenneth J. Warrington, MD
Professor of Medicine
Mayo Clinic College of Medicine
Rochester
MN
利益声明
KJW’s employer receives payments from Eli Lilly, GSK, and Kiniksa for his role as investigator in giant cell arteritis clinical trials. KJW has conducted consulting work for Sanofi, and received compensation from Roche/Genentech for lecturing. He has received honoraria and consulting fees from Chemocentryx. KJW is an author of a number of references cited in this topic.
鸣谢
Dr Kenneth J. Warrington wishes to gratefully acknowledge Dr Eric L. Matteson, a previous contributor to this topic.
利益声明
ELM’s employer has received payments from Bristol Myers Squibb and GlaxoSmithKline for his role as investigator in giant cell arteritis clinical trials; from Novartis for his role in polymyalgia rheumatica clinical trials; and from GlaxoSmithKline for his role as an advisory consultant. ELM is an author and editor for Up To Date and Paradigm, as well as an author of a number of references cited in this topic.
同行评议者
Anisha B. Dua, MD, MPH
Associate Professor
Northwestern University Feinberg School of Medicine
Chicago
IL
利益声明
ABD declares they have paid consultancies from Amgen, Abbvie, Novartis, GSK and Sanofi. ABD is on the board of directors for the Vasculitis Foundation.
Kuntal Chakravarty, FRCP (London), FRCP (Glasgow), FRCP (Ireland), FACP (USA), FACR (USA)
Consultant Rheumatologist
BHRT University Hospital
Queen’s Hospital
Romford
UK
利益声明
KC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Ponte C, Grayson PC, Robson JC, et al. 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Arthritis Rheumatol. 2022 Dec;74(12):1881-9. 摘要
Maz M, Chung SA, Abril A, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis. Arthritis Rheumatol. 2021 Aug;73(8):1349-65.全文 摘要
Dejaco C, Ramiro S, Bond M, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update. Ann Rheum Dis. 2024 May 15;83(6):741-51.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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