Diagnosis and differential diagnosis of giant cell arteritis -- clinical medical theory

 Diagnosis and differential diagnosis of giant cell arteritis -- clinical medical theory

Unexplained fever, burnout, weight loss, anemia and ESR > 50mm / h in the elderly over 50 years old; Recent headache and visual impairment (blackness, blurred vision, diplopia and blindness); Or other signs of insufficient blood supply of cranial artery, such as intermittent arterial disorder of masticatory muscle, tinnitus, vertigo, etc; Or PMR syndrome should be suspected, and further examination, such as temporal arteriography and temporal artery embolus, should be carried out to determine the diagnosis. If conditions do not permit, glucocorticoid treatment can be tried out after excluding other rheumatic diseases.

GCA should be distinguished from other vascular inflammatory diseases:

1. Nodular polyarteritis

The disease mainly invades small and medium-sized arteries, such as renal artery, celiac artery or mesenteric artery, and rarely involves temporal artery.

2. Allergic vasculitis

The disease mainly involves small blood vessels, venules or capillaries of the skin, with obvious skin lesions such as maculopapular rash, papule, purpura, ecchymosis, nodule, ulcer, etc.

3. Granulomatous polyangitis (Wegener granuloma)

Necrotizing granuloma of upper and lower respiratory tract, generalized small and medium arteritis and focal necrotizing glomerulonephritis were the main features.

4. Aortic arch arteritis

Aortic arch arteritis has a wide range of lesions, often causing segmental arterial stenosis, arterial dilation before and after occlusion or narrowing, and GCA invading the aorta is rare. In addition, it should be distinguished from fever, headache, anemia and blindness caused by malignant tumor, systemic or systemic infection or other reasons.