A 68-year-old woman presented to the hospital with a 2-day history of left-eye blindness and a discolored lower lip and tongue. One week prior she presented to her dentist complaining her dentures were not fitting correctly and was treated for thrush. She was previously in good health and never had visual or oral complaints.
Figures 83-1 and 83-2 demonstrate how giant cell arteritis (GCA) can present with nonspecific findings yet cause significant ischemia and organ damage. Below is a comparison demonstrating how GCA and Takayasu arteritis (TA) are points on a continuum of an inflammatory clinical process differing by age of onset, pathogenic mechanism, and the vascular beds commonly affected.
Giant cell arteritis (GCA) presenting with blindness and ptosis of the left eye. Note the swollen, discolored lower lip and left temporal necrotic tissue.
Giant cell arteritis (GCA) patient with a necrotic lower lip and left side of the tongue.
Increasing frequency with age and average age of diagnosis 72 years.1
Women are more likely affected than men.2
Prevalence up to 1 in 500 among individuals older than 50 years.2
Northern European ancestry living in the United States or Europe.3
History of smoking and atheromatous disease increase risk in women.4
Human leukocyte antigen (HLA)-DR4 positivity.4
80% to 90% of cases are in women between the ages of 10 and 40.
Greatest prevalence in Asia. Japan reports 150 new cases per year compared to one to three new cases per million people in the United States and Europe.5
Additional risk factors: HLA-B52, HLA-B39 positivity.
ETIOLOGY AND PATHOPHYSIOLOGY
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