Ninet J P, Bachet P, Dumontet C M, Du Colombier P B, Stewart M D, Pasquier J H
Département de Médecine Interne, Hôpital Edouard Herriot, Lyon, France.
Am J Med. 1990 Jan;88(1):13-20. doi: 10.1016/0002-9343(90)90121-s.
We describe 10 female patients with temporal arteritis (TA) and/or polymyalgia rheumatica (PMR) who presented with upper-extremity ischemia.
PATIENTS, METHODS, AND RESULTS: Arm claudication or Raynaud's phenomenon was the initial manifestation of the disease in four cases, appeared with classical symptoms in one case, or occurred during decreasing corticosteroid therapy in five cases. Temporal artery biopsy was performed in nine patients and showed typical giant-cell granulomatous arteritis in seven cases. Angiograms in all cases showed multiple bilateral smooth stenoses, or obliterations of postvertebral subclavian and/or axillary arteries, or both. Symptoms always improved with corticosteroid treatment and none of the patients required reconstructive surgery, although angiography performed after stabilization did not show revascularization of occluded vessels.
We conclude that large-artery involvement in TA and PMR affects most commonly the subclavian and axillary arteries, with a female predominance comparable to that in Takayasu's arteritis. Both these disorders should be considered in elderly women with occlusive disease of the upper extremities. Although response to steroid therapy was sufficient in our series to avoid surgery, we believe it is preferable to recognize large-artery involvement as early as possible and recommend performance of ultrasonic Doppler examination when any sign of oncoming ischemia or stenosis is observed.
我们描述了10例患有颞动脉炎（TA）和/或风湿性多肌痛（PMR）并出现上肢缺血的女性患者。
患者、方法和结果：4例患者以手臂间歇性跛行或雷诺现象为疾病的初始表现，1例伴有典型症状，5例在皮质类固醇治疗减量期间出现。9例患者进行了颞动脉活检，7例显示典型的巨细胞肉芽肿性动脉炎。所有病例的血管造影均显示双侧多发平滑狭窄，或椎动脉后锁骨下动脉和/或腋动脉闭塞，或两者皆有。症状经皮质类固醇治疗后均有改善，尽管稳定后进行的血管造影未显示闭塞血管再通，但无一例患者需要进行重建手术。
我们得出结论，TA和PMR中的大动脉受累最常影响锁骨下动脉和腋动脉，女性患病率与高安动脉炎相当。对于患有上肢闭塞性疾病的老年女性，应考虑这两种疾病。尽管在我们的系列研究中，对类固醇治疗的反应足以避免手术，但我们认为最好尽早识别大动脉受累情况，并建议在观察到任何即将出现缺血或狭窄迹象时进行超声多普勒检查。
