小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 头痛
- 风湿性多肌痛
- 四肢跛行
- 其他颅动脉异常
- 视力丧失
- 下颌运动障碍
- 颞浅动脉触痛、增厚，或结节感
- 颞动脉搏动消失
- 眼底镜检查异常
其他诊断因素
- 全身症状
- 神经系统症状
- 咳嗽、咽痛、声嘶
- 听诊杂音
- 血压不对称
- 肩膀触痛
- 肩部和髋部活动范围受限
- 手腕和膝关节肿胀
危险因素
- 50 岁以上
- 女性
- 遗传因素
- 吸烟
- 动脉粥样硬化
- 环境因素
诊断性检查
首要检查
- 红细胞沉降率 (ESR)
- C 反应蛋白 (CRP)
- 全血细胞计数（FBC）
- 肝功能检查 (LFT)
- 颞动脉活检
- 颞动脉超声
需考虑的检查
- 主动脉弓血管造影术
新兴检查
- 头部至大腿中部的 FDG-PET 扫描
- 上肢动脉的超声扫描
治疗流程
疑似巨细胞动脉炎
确诊巨细胞动脉炎
撰稿人
作者
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 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. 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 Meyers 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
Gene Hunder, MD
Professor of Rheumatology
Mayo Clinic
Rochester
MN
利益声明
GH declares that he has no competing interests.
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.
鉴别诊断
- 风湿性多肌痛 (PMR)
- 实体器官肿瘤和血液恶性肿瘤
- 大动脉炎 (TA)
更多 鉴别诊断指南
- 2021 年美国风湿病学会/血管炎基金会巨细胞动脉炎和大动脉炎管理指南
- 英国风湿病学会有关巨细胞动脉炎的诊断和治疗指南
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