[A 58-year-old soldier with a history of weight loss and exercise intolerance. Giant cell arteritis]. / 58-jähriger Berufssoldat mit Gewichtsverlust und reduzierter Leistungsfähigkeit. Riesenzellarteriitis.

We report the case of a 58-years-old soldier with a history of movement related neck pain, weight loss and exercise intolerance. Blood tests presented signs of an inflammatory syndrome. The CT-scan showed extended thickening of the aortic wall characteristic for aortitis. The diagnosis of giant cell arteritis could be histologically confirmed by biopsy of the temporal arteries. Our case report emphasizes the importance of the various imaging modalities. We discuss the different forms of disease evolution and the treatment regimen.

A novel therapeutic option in Cogan diseases? TNF-alpha blockers.

Cogan's syndrome is characterized by noninfectious, interstitial keratitis combined with a vestibulo-auditory deficit. Despite therapy with corticosteroids in combination with immunosuppressive agents, relapses occurred in two subjects and the clinical course suggested a progression of the disease. Treatment with anti-TNF-alpha was started leading to a rapid and sustained clinical remission for over 2 respectively 3 years.

[Polymyalgia rheumatica--fibromyalgia-syndrome: symptoms, syndromes or diseases?]. / Polymyalgia rheumatica--Fibromyalgie-syndrom: Symptome, Syndrome oder Krankheiten? Begriffe und deren Inhalte.

Polymyalgia rheumatica and Fibromyalgia are probably not distinct clinical entities. Rather polymyalgia rheumatica is the common denomiator of a large spectrum of different diseases. The historical separation between Polymyalgia rheumatica and Giant-Cell Arteritis is no more clinically applicable in most cases. A better clinical approach is to view them as extrems of a continuum. Similarly, fibromyalgia is one manifestation of chronic pain syndromes of undetermined etiology. In addition, fibromyalgia can often not be delineated clearely from functional disorders, including depression.

[62-year-old patient with chronic pain in the area of the carotid arteries]. / 62jährige Patientin mit chronischen Schmerzen im Bereich der Karotiden.

A 62-year-old woman was admitted for investigation of severe chronic recurring lateral neck pain radiating to the face with predilection for the right side for 30 years. The main clinical finding was tenderness of the extracranial carotid arteries (Fay's sign). The ultrasound-investigation of the neck- and brain-arteries did not reveal any pathological findings. The laboratory investigations provided no evidence of inflammation but revealed primary hyperparathyreoidism. Lateral radiating neck pain with tenderness of the carotid arteries are summarized under the term carotidynia, provided no pathological changes of the arteries are found. Whether carotidynia actually is an entity is uncertain. Nevertheless it is suggested to maintain the term for a carotid pain-syndrome whenever dangerous pathological conditions of the carotid arteries have been ruled out. In acute varieties which normally respond to NSAID a infectious aetiology has been postulated. Chronic carotidynias are probably a variety of migraine and tend to resolve with an antimigraineous therapy. There do not exist any reports on the coincidence of carotidynia and hyperparathyreoidism. After an attempt for parathyreoidectomy which failed because of extensive local scaring the patient was persistently free of pain without any obvious pathophysiological explanation for this fact.