Sverdlichenko Irina, Xie Jim Shenchu, Lu Brianna, Tao Brendan, Lai Abbie, Naidu Sumana, Wong Jovi, Handzic Armin, Micieli Jonathan, Margolin Edward
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Gen Intern Med. 2025 Feb;40(3):659-665. doi: 10.1007/s11606-024-09141-7. Epub 2024 Oct 31.
Giant cell arteritis can present with atypical manifestations that delay treatment and risk severe complications.
To comprehensively describe all atypical signs/symptoms of giant cell arteritis.
In this systematic review, we searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to October 2022. Primary research articles that included at least one participant with an atypical sign/symptom of biopsy-proven giant cell arteritis were included. Study screening and data extraction were performed in duplicate. The primary outcome was the proportion of participants with atypical giant cell arteritis features. Time to treatment was compared between participants with atypical giant features only and participants with both typical and atypical features.
Of 21,828 screened records, 429 studies corresponding to 746 individuals (median [IQR] age 72 [IQR, 66-78] years, 63% female) with at least one atypical feature of GCA were included. Eighty-two percent had both atypical and at least one concurrent typical giant cell arteritis feature, whereas 18% of patients with atypical signs and symptoms only presented with atypical features. Patients with atypical symptoms presented to clinicians earlier than patients with typical features (p < 0.001). There was no difference between groups in proportion to elevated ESR and CRP (82.3% vs. 83.35%, p = 0.91) or mortality rate (8.2% vs. 10.8%, p = 0.42). Patients with atypical features only experienced greater delay in treatment initiation (p < 0.001). The most commonly reported atypical signs/symptoms were vertigo (11.9%), scalp necrosis/ulceration (7.9%), and dry cough (5.8%).
Eighteen percent of biopsy-proven giant cell arteritis cases with at least one atypical feature have only atypical features and are more likely to experience delays in treatment. Clinicians should be aware of atypical signs/symptoms of giant cell arteritis and order inflammatory markers early to prevent giant cell arteritis-associated morbidity.
巨细胞动脉炎可表现为非典型症状，从而延误治疗并增加严重并发症的风险。
全面描述巨细胞动脉炎的所有非典型体征/症状。
在这项系统评价中，我们检索了从创刊至2022年10月的MEDLINE、Embase和Cochrane对照试验中心注册库。纳入至少有一名经活检证实的巨细胞动脉炎非典型体征/症状参与者的原始研究文章。研究筛选和数据提取由两人独立进行。主要结局是具有非典型巨细胞动脉炎特征的参与者比例。比较仅具有非典型特征的参与者与同时具有典型和非典型特征的参与者的治疗时间。
在21828条筛选记录中，纳入了429项研究，涉及746名个体（年龄中位数[四分位间距]为72岁[四分位间距，66 - 78岁]，63%为女性），这些个体至少具有一项巨细胞动脉炎的非典型特征。82%的个体既有非典型特征，又至少有一项同时存在的典型巨细胞动脉炎特征，而18%仅有非典型体征和症状的患者仅表现为非典型特征。有非典型症状的患者比有典型特征的患者更早就诊于临床医生（p < 0.001）。两组在血沉（ESR）和C反应蛋白（CRP）升高比例（82.3%对83.35%，p = 0.91）或死亡率（8.2%对10.8%，p = 0.42）方面无差异。仅有非典型特征的患者在开始治疗时经历了更大的延迟（p < 0.001）。最常报告的非典型体征/症状是眩晕（11.9%）、头皮坏死/溃疡（7.9%）和干咳（5.8%）。
经活检证实的至少具有一项非典型特征的巨细胞动脉炎病例中，18%仅有非典型特征，且更有可能经历治疗延迟。临床医生应了解巨细胞动脉炎的非典型体征/症状，并尽早开具炎症标志物检查，以预防巨细胞动脉炎相关的发病情况。
