Lower limb giant cell arteritis and temporal arteritis: Followup of 8 cases

Among 8 patients with giant cell arteritis (GCA) (6 women, 2 men) whose cli nical presentations were compatible with temporal arteritis (TA), 6 were fo llowed for 37-105 (mean 74.9) months, one died shortly after treatment onse t, and the last was asymptomatic (10 mg steroids/day) when lost to followup at 29 months. All 8 patients had bilateral leg claudication of recent onse t; for 6 patients, this was the first symptom. All leg angiograms showed mu ltiple, bilateral, long and smooth stenoses, thromboses, or both. Biopsies of diseased leg arteries from 4 patients provided histological proof of GCA ; another case was histologically proven post mortem. Among the 5 patients who met at least 3 American College of Rheumatology criteria of GCA or TA, 3 without histologically documented leg GCA also had biopsy proven temporal GCA (n = 1), or headaches and claudication and angiographic inflammatory a rteritis of the arms (n = 2). All patients received steroids; 3 had bypasse s, one with endarterectomy. Five are asymptomatic after 24-100 months of st eroids (mean 50.6). Revascularization was not successful; one amputation wa s necessary. Large artery involvement in GCA can affect the legs. Bilateral and rapidly progressive intermittent claudication of recent onset is the m ost common symptom, even in the absence of headaches or the presence of a s ilent inflammatory syndrome. Early diagnosis allows rapid initiation of ste roid therapy, which is usually able to generate a sufficiently good respons e to avoid vascular surgery.