Jaw claudication

Abstract: Polymyalgia rheumatica is a relatively common syndrome of older patients, mostly white, manifested by aching and morning stiffness of the pelvic and shoulder girdles and accompanied by a rapid erythrocyte sedimentation rate. The symptoms are due to a synovitis, which is mild, nondestructive and very responsive to low-dose steroid treatment, which may need to be continued for several years. Temporal arteritis, which may accompany polymyalgia, can present as headache, loss of vision, diplopia or jaw claudication. To suppress arterial inflammation and preserve vision, administration of prednisone, 50 mg a day for one month, is recommended, following which the dose is tapered according to the symptoms, not the sedimentation rate.

Abstract: Among the population of Olmsted County, Minnesota, 42 patients with temporal arteritis were identified during a 25-year period. The average annual incidence per 100 000 population aged 50 and older rose from 5.1 in 1950-1959 to 17.4 in 1970-1974. The prevalence of patients with a history of the diagnosis of temporal arteritis on 1 January 1975 was 133 per 100 000 population aged 50 and older. All patients received corticosteroid therapy for a range of 1 to 77 months (median, 7 months). Relapses in 10 of 11 patients were associated with corticosteroid reduction. The majority of patients recovered fully and were followed off corticosteroids for 10 months to 19 years (median, 5 years). Temporal arteritis had no significant effect on survival. Vertebral compression fractures and myopathy were the most serious complications of therapy. The presence of giant cells in biopsies was in part related to the number of sections examined, and their presence had no apparent influence on the clinical course.

Abstract: Objective Cranial ischemic complications such as cerebrovascular accidents (CVAs) and acute visual loss are among the leading causes of giant cell arteritis (GCA)–related morbidity In this retrospective study, we evaluated the effect of treatment with low-dose aspirin on the incidence of cranial ischemic complications in GCA Methods Charts of 175 consecutive patients in whom GCA was diagnosed between 1980 and 2000 were reviewed for medical data Data for 166 patients who were followed up for at least 3 months were also available Results At the time of the diagnosis of GCA, 36 patients (21%) had already been receiving low-dose aspirin (100 mg/day) In all cases, the indication for this treatment was ischemic heart disease There were no significant differences between the aspirin-treated and non–aspirin-treated groups regarding the mean age of patients, the male-to-female ratio, duration of GCA-related symptoms, rates of headaches, systemic symptoms, and jaw claudication, and the mean erythrocyte sedimentation rate, hemoglobin count, and platelet count Cerebrovascular risk factors (hypertension, hyperlipidemia, or diabetes mellitus) were more common in the aspirin-treated group (389% versus 20%; P= 003) Cranial ischemic complications were diagnosed in 43 patients at presentation: 30 patients had acute visual loss, 11 had CVAs, and 2 had both conditions simultaneously Only 3 of the aspirin-treated patients (8%) presented with cranial ischemic complications, compared with 40 (29%) of the non–aspirin-treated patients (P = 001) Despite the use of steroid therapy, cranial ischemic complications developed in 14 of the 166 patients followed up for 3 months or longer However, cranial ischemic complications developed in only 3% of the aspirin-treated patients, compared with 13% of the patients treated with prednisone only (P = 002) Conclusion These data suggest that low-dose aspirin decreases the rate of visual loss and CVAs in patients with GCA