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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 52, Num. 3, 2004, pp. 397-398

Neurology India, Vol. 52, No. 3, July-September, 2004, pp. 397-398

Letter To Editor

Giant cell arteritis as a cause of jaw claudication

Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012

Correspondence Address:Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012

Code Number: ni04135

Giant cell arteritis (GCA), a systemic panarteritis involving medium and large arteries[1] has rarely been reported from India.[2] We report an elderly female who presented with fever and jaw claudication.

A 65-year-old housewife was admitted with a history of low-grade pyrexia for 10 weeks. A few days later she started having moderately severe throbbing headache, which was more marked on the right side and was especially in the temporal and occipital regions. In addition, she had jaw claudication, which gradually increased in intensity. All peripheral pulsations were normal except for the right temporal artery which was not palpable and the left temporal artery was feeble. The facial artery on right side was cord-like and no pulsations could be felt. Systemic examination was normal. Temporal artery biopsy (right side) revealed intimal proliferation with medial hypertrophy. Elastic lamini revealed disruption. There was moderate chronic inflammatory infiltrate with a few giant cells [Figure - 1] and [Figure - 2]. The patient was treated with steroids (prednisolone -0.3 mg/kg/body wt.) to which she responded rapidly with disappearance of both headache and fever. Steroids were continued on the same dose for a month after which the dose was tapered.

Giant cell arteritis also known as temporal arteritis is a chronic vasculitis of medium and large-sized arteries.[1] It usually involves the cranial branches of the arteries arising from the aortic arch. It generally manifests as fever of low grade and headache, especially over the temporal and occipital areas.[3] On physical examination the frontal and parietal branches of the superficial temporal artery are tender, thickened, nodular or may be absent. Jaw claudication occurs in half of the cases. The other manifestations are partial or permanent loss of vision, mononeuritis multiplex, peripheral neuropathy and strokes involving the territory of the affected artery.[4]

Laboratory investigations usually reveal elevated ESR and C-reactive protein, anemia, generally normocytic normochromic, thromocytosis and decreased serum albumin. Liver enzymes may be elevated. Temporal artery biopsy is diagnostic.[5] The response to corticosteroids is usually rapid. However, 30-50% patients have spontaneous exacerbations and may re quire cytotoxic agents like methotrexate.[1]


1.Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant cell arteritis. N Eng J Med 2002;347:261-71.  Back to cited text no. 1    
2.Sood R, Zulfi H, Ray R, HandaR, Wali JP. Giant cell arteritis-a rare cause of fever of unknown origin in India.. J Assoc Physc India 2002;50:846-8.   Back to cited text no. 2    
3.Calamia KT, Hunder GG. Clinical manifestations of giant cell (temporal) arteritis. Clin Rheum Dis 1980;6:389-403.  Back to cited text no. 3    
4.Gonzalez-Gay MA, Blanco R, Roriguez- Vavarde V, et al. Permanent visual loss and cerebro-vascular accidents in giant cell arteritis: Predictors and response to treatment. Arth Rheumatism 1998;41:1497-504.  Back to cited text no. 4    
5.Hall S, Hunder GG. Is temporal artery biopsy prudent? Mayo Clin Proc 1984;59:793-6.  Back to cited text no. 5    

Copyright 2004 - Neurology India

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