Resumo
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- cefaleia
- sintomas de polimialgia reumática
- idade avançada
- claudicação de membros
- perda súbita de visão
- claudicação mandibular
- sensibilidade arterial, espessamento ou nodularidade
- ausência de pulso da artéria temporal
- fundoscopia anormal
Other diagnostic factors
- sintomas sistêmicos
- tosse, faringite, rouquidão
- sintomas neurológicos
- sopro na auscultação
- pressão arterial assimétrica
- sensibilidade dos ombros
- amplitude de movimento ativa dos ombros e quadril limitada
- edema do punho e joelho
- dor de dente e dor ou infarto linguais
Risk factors
- idade ≥50 anos
- sexo feminino
- fatores genéticos
- tabagismo
- aterosclerose
- fatores ambientais
Diagnostic investigations
1st investigations to order
- proteína C-reativa
- velocidade de hemossedimentação (VHS)
- Hemograma completo
- TFHs
- biópsia da artéria temporal
- ultrassonografia da artéria temporal
Investigations to consider
- Exames de imagem vascular não invasivos
Emerging tests
- tomografia por emissão de pósitrons com fluordesoxiglucose (FDG-PET) da cabeça até a metade da coxa
Treatment algorithm
suspeita de arterite de células gigantes
arterite de células gigantes confirmada
Contributors
Authors
Kenneth J. Warrington, MD
Professor of Medicine
Mayo Clinic College of Medicine
Rochester
MN
Disclosures
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.
Acknowledgements
Dr Kenneth J. Warrington wishes to gratefully acknowledge Dr Eric L. Matteson, a previous contributor to this topic.
Disclosures
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.
Peer reviewers
Anisha B. Dua, MD, MPH
Associate Professor
Northwestern University Feinberg School of Medicine
Chicago
IL
Disclosures
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
Disclosures
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.
References
Key articles
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. Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Polimialgia reumática (PMR)
- Cânceres de órgãos sólidos e neoplasias hematológicas
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