Le Hello C, Lévesque H, Jeanton M, Cailleux N, Galateau F, Peillon C, Veyssier P, Watelet J, Letellier P, Courtois H, Maïza D
Departments of Thoracic and Cardiovascular Surgery, Pathology and Internal Medicine, Centre Hospitalier Universitaire de Caen, Caen, France.
J Rheumatol. 2001 Jun;28(6):1407-12.
Among 8 patients with giant cell arteritis (GCA) (6 women, 2 men) whose clinical presentations were compatible with temporal arteritis (TA), 6 were followed for 37-105 (mean 74.9) months, one died shortly after treatment onset, and the last was asymptomatic (10 mg steroids/day) when lost to followup at 29 months. All 8 patients had bilateral leg claudication of recent onset; for 6 patients, this was the first symptom. All leg angiograms showed multiple, bilateral, long and smooth stenoses, thromboses, or both. Biopsies of diseased leg arteries from 4 patients provided histological proof of GCA; another case was histologically proven post mortem. Among the 5 patients who met at least 3 American College of Rheumatology criteria of GCA or TA, 3 without histologically documented leg GCA also had biopsy proven temporal GCA (n = 1), or headaches and claudication and angiographic inflammatory arteritis of the arms (n = 2). All patients received steroids; 3 had bypasses, one with endarterectomy. Five are asymptomatic after 24-100 months of steroids (mean 50.6). Revascularization was not successful; one amputation was necessary. Large artery involvement in GCA can affect the legs. Bilateral and rapidly progressive intermittent claudication of recent onset is the most common symptom, even in the absence of headaches or the presence of a silent inflammatory syndrome. Early diagnosis allows rapid initiation of steroid therapy, which is usually able to generate a sufficiently good response to avoid vascular surgery.
在8例临床表现符合颞动脉炎（TA）的巨细胞动脉炎（GCA）患者中（6例女性，2例男性），6例随访了37 - 105个月（平均74.9个月），1例在治疗开始后不久死亡，最后1例在29个月失访时无症状（每日服用10毫克类固醇）。所有8例患者近期均出现双侧下肢间歇性跛行；6例患者以此为首发症状。所有下肢血管造影均显示多处双侧、长且光滑的狭窄、血栓形成或两者皆有。4例患者病变下肢动脉活检提供了GCA的组织学证据；另一例经尸检组织学证实。在至少符合3条美国风湿病学会GCA或TA标准的5例患者中，3例下肢GCA无组织学记录的患者也经活检证实有颞部GCA（1例），或头痛、间歇性跛行以及手臂血管造影显示炎性动脉炎（2例）。所有患者均接受了类固醇治疗；3例行搭桥手术，1例行动脉内膜切除术。5例患者在接受类固醇治疗后24 - 100个月（平均50.6个月）无症状。血管重建未成功；1例需要截肢。GCA累及大动脉时可影响下肢。近期发作的双侧快速进展性间歇性跛行是最常见的症状，即使没有头痛或存在无症状性炎症综合征。早期诊断可使类固醇治疗迅速开始，这通常能够产生足够好的反应以避免血管手术。
