055 Giant cell arteritis presenting with upper limb claudication

Abstract

Background: Upper limb claudication as a presenting feature of giant cell arteritis is rare. We describe here a case without the usual symptoms or signs of the disorder, which typically include headache, temporal tenderness, amaurosis fugax, jaw claudication and associated polymyalgia. Method(s): A 53 year old female was seen in the rheumatology clinic with an established diagnosis of a seronegative inflammatory arthritis which was well controlled for many years on methotrexate and sulphasalazine. She gave a six month history of increasing lethargy, joint pains and episodes of blurred vision with floaters but no associated headaches, jaw claudication or scalp tenderness. She also reported unintentional weight loss of 1stone over sixmonths, episodic pallor affecting her left hand and a history of bilateral upper limb claudication. On examination she had an absent left radial pulse, a cool left hand but no bruits. BP in the left arm 90/56 and right arm 135/70. There was no thickening or tenderness of the temporal arteries and fundoscopy was normal with no evidence of an anterior ischaemic optic neuropathy. There was no synovitis clinically. Bloods revealed a Hb of 98, WC 10.2, platelet count of 414. Her ESR was 111 and CRP 46. Na 131