Diagnosis and Treatment of Giant Cell Arteritis (Temporal Arteritis) – Past, Current and Future Aspects

Abstract

Giant cell (temporal) arteritis (GCA) is characterized by a granulomatous inflammatory reaction that penetrates all layers of the wall of mediumto large-sized arteries (1). The transmural vasculitis is particularly prone to involve cranial arteries such as the superficial temporal artery (TA), but not infrequently the disease extends to involve large muscular arteries including the subclavian and axillary arteries and the aorta. The earliest recorded description of GCA dates to the 10th century when Ali Ibn Isa of Baghdad in his memorandum book remarked on the relationship between inflamed arteries and visual symptoms (2). An even earlier case of GCA is disclosed in a photograph of carving of a blind harpist with swollen eyelids and prominent temporal arteries from a Egyptian tomb of Pa-Aton-Em-Heb dating back to 1350 BC (3). Moreover, the painting by the Flemish painter Jan van Eyck (1436) “The holy Virgin with Canon van der Paele” may also represent an early case of GCA (4). The canon had prominent temporal arteries and diffuse swelling of the hand (5), the latter possibly indicating coexistent PMR. The tortous and inflamed artery seen in the portrait of Lorenzo Gambietti by Piero di Cosimo in 1502 is also suggestive of GCA (5). Thus, although GCA may have existed for several centuries there are rather few definite historical documentations of its existence. As GCA preferentially affects persons aged 50 years and more, one possible explanation is the low average life expectancy in ancient times, exposing few individuals to the risk of contracting GCA. The first clinical description of GCA was given by Jonathan Hutchinson in 1890 (St. Bartholomew`s Hospital, London) who was asked to examine Mr. Rumbold, an 80 year old father of a porter at the London Hospital who had “red streaks on his head” which were so painful that they prevented him from wearing a hat (6). Forty-two years later (1932), the first histopathological evidence of a granulomatous vasculitis in the temporal arteries was reported by Horton, Magath and Brown at a Mayo Clinic staff meeting in 1932 (7). In 1937, Horton and Magath added to their former report the prominence of headache, the difficulty chewing food, and transient diplopia (8). Blindness as a complication of GCA was, however, first recognized by Jennings in 1938 (9). In 1941, Gilmoure (10) suggested the presence of giant cells as characteristic for the disease which he called “giant cell chronic arteritis”.