SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

10/16/06

Head and neck swelling in temporal (giant cell) arteritis

Summary
Background – Head -related symptoms such as jaw claudication are common in temporal arteritis (TA). Do such manifestations include head and neck swelling (HNS)?

Findings – Liozon et al of the Univ Hospital in Limoges, France reviewed their experience in 260 consecutive patients with a diagnosis of TA. They found that HNS occurred in 6.7% of their TA patients, frequently painful, and often as the initial manifestation of TA in those TA patients exhibiting HNS. The HNS most commonly involved the orbital region and face (generally the maxillary area), less commonly the neck, and rarely the forehead and tongue.

Ears-nose-throat symptoms and jaw claudication commonly accompanied the HNS, but visual loss and stroke were not common in those with HNS, The temporal artery biopsies showed giant cell arteritis in almost all those with HNS. The HNS was generally transient with and without the treatment of the TA and recurrences of the HNS were unusual.

Reference
Clin Exp Rheumatol 2006;24: (2 Suppl 41): S20-5

Editor's Comments
These findings should alert the clinician to consider TA in middle aged and older individuals who present with idiopathic facial swelling, particularly if painful. A markedly elevated sedimentation rate should prompt further investigation for TA and possible accompanying polymyalgia rheumatica, including a temporal artery biopsy when indicated. It is not clear to me whether the infrequent occurrence of visual manifestations in TA patients with HNS indicates that HNS is marker of a particular sub-type of TA.

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