Edema facial como manifestación inicial atípica de arteritis de células gigantes: a propósito de un caso y revisión de la literatura / Facial edema as an atypical initial manifestation of giant cell arteritis: a case report and review of the literature

Introducción: la arteritis de células gigantes es la vasculitis de vaso grande más frecuente y se ve predominantemente en adultos ma-yores de 50 años. El diagnóstico es en base a la clínica que se compone de cefalea, polimialgia reumática, sensibilidad en relación a la arteria temporal, compromiso del estado general, entre otras cosas, más laboratorio que se evidencia reactantes de fase aguda elevados y anemia y se confirma con biopsia de arteria temporal. Métodos: reporte de un caso de una paciente con debut con cefalea y aumento de volumen facial, lo que conllevó un diagnóstico erróneo de celulitis facial. Debido a esta presentación atípica, se retrasó el diagnóstico de arteritis de la temporal y tratamiento oportuno. Resultados: la arteritis de células gigantes es una patología que posee un gran rango de presentaciones atípicas, lo que ocurre en hasta un 38% de los pacientes que poseen la enfermedad, manifestaciones que incluyen neuralgia del trigémino, infartos linguales, aneurismas aórticos, edema facial, entre otros. Conclusión: es muy relevante conocer las presentaciones atípicas de esta patología que son muy frecuentes de encontrar en los pacientes y conocerlas nos permite aumentar nuestra sospecha clínica permitiendo un diagnóstico y tratamiento oportuno, evitando consecuencias irreversibles por el retraso diagnóstico.

Introduction: giant cell arteritis is the most frequent large vessel vasculitis and is seen predominantly in adults over 50 years. The diag-nosis is based on the clinic that is composed of headache, polymyalgia rheumatic, sensitivity near the temporal artery, compromise of the general condition, among other things, added to a laboratory that is evidenced like severe acute phase reactants and anemia and finally, is confirmed with temporal artery biopsy. Methods: a case report of a patient who debuted with headache and increased facial volume that led to a wrong diagnosis of facial cellulite. Because of this atypical presentation of the disease, the diagnostic took more time than usual and delayed the accurate diagnosis and timely treatment; this could have caused irreversible consequences. Results:giant cell arteritis has a wide range of atypical presentations; this may occur even up to 38% of patients that have this disease; manifes-tations include: trigeminal neuralgia, lingual infarct, aortic aneurysm, facial edema, and other symptoms. Conclusion: it is important to study the atypical presentations of this pathology because they are usually founded in patients. If we are informed about the atypical presentations, we can increase our clinical suspicion, and that allows us to get the right diagnosis and opportune treatment, avoiding irreversible consequences because of a late diagnosis.

A case of dural arteriovenous fistula suspected temporal arteritis and literature review / 中国脑血管病杂志

Dural arteriovenous fistula is a rare subtype of intracranial arteriovenous malformation, accounting for 10%-15% of all intracranial vascular malformations, with the characteristic of pathological anastomosis between the dural branch of the dural artery or intracranial artery and dural vein, or meningeal vein, or cortical vein. In this paper, a patient with headache suspected of temporal arteritis was analyzed retrospectively. Ultrasonography showed that arteriovenous fistula supplied by bilateral branches of the superficial temporal artery of the external carotid artery is likely. Finally, a dural arteriovenous fistula was diagnosed using digital subtraction angiography. The case shows that patients with headaches should also pay attention to other rare diseases causing headaches excepted for the temporal arteritis in practice.

Necrosis lingual como forma de presentación de arteritis temporal / Lingual necrosis as a form of presentation of temporary arteritis

La arteritis de células gigantes es una vasculitis sistémica que compromete arterias de mediano y gran calibre, principalmente la arteria aorta y sus ramas. Su prevalencia es mayor en mujeres a partir de los 50 años, típicamente se manifiesta con fiebre, claudicación mandibular, cefalea, hiperestesia del cuero cabelludo y pérdida de la visión con neuropatía óptica isquémica anterior, en una minoría de casos aparecen síntomas menos frecuentes que dificultan y retrasan el diagnóstico. Se presenta el caso de una mujer de 76 años que consultó por dolor en la cavidad bucal con edema lingual y en cuello de 48 horas de evolución asociado a cefalea el mes previo. En el examen físico presentaba signos clínicos de isquemia lingual, por lo que se consideró como diagnóstico presuntivo compromiso isquémico por arteritis de células gigantes, e inició tratamiento con corticoides sistémicos realizándose una biopsia de arteria temporal que evidenció infiltrado linfocitario panparietal con engrosamiento de la túnica íntima y hallazgos compatibles con panarteritis. La arteritis de células gigantes debe ser sospechada en pacientes con manifestaciones de isquemia lingual, iniciándose en forma precoz el tratamiento para evitar complicaciones irreversibles.

Giant cell arteritis is a systemic vasculitis that affects arteries of medium and large caliber, mainly the aorta artery and its main branches. It is more frequent in women older than 50 years. The most common symptoms are fever, jaw claudication, headache, hyperesthesia of the scalp and loss of vision with anterior ischemic optic nerve disease. But, in a minority of cases, less frequent symptoms are observed that delay and make more difficult the diagnosis. Here, we present the case of a 76-year-old woman who came to our consultation having pain in the oral cavity and presenting tongue and neck edema for 48 hours. She had also suffered from headaches during the previous month. Because the physical examination showed clinical signs of lingual ischemia, a presumptive diagnosis of ischemic involvement due to giant cell arteritis was considered. She started a treatment with systemic corticosteroids and a temporal artery biopsy was performed. We conclude, that giant cell arteritis should be suspected in patients presenting lingual ischemia symptoms in order to start the specific treatment early enough to avoid irreversible complications.

Concurrent bilateral juvenile temporal arteritis and hypereosinophilic syndrome: a case report and review of the literature

Most of temporal arteritis occurs in the older patient over 50 years old, and the histopathologic finding shows a granulomatous inflammation, so this called giant cell arteritis. However, the young patients also present with a nodular lesion in their temple, and juvenile temporal arteritis (JTA) should be considered as one of the differential diagnosis, although it is very rare. For both diagnosis and treatment of JTA, excisional biopsy is essential. The pathologic finding of the temporal artery shows panarteritis with lymphoeosinophilic infiltrates, but no giant cell or granulomatous lesion. JTA is a localized disease with low level of systemic inflammatory marker, so the symptom is usually relieved by excision of affected lesion. Peripheral blood eosinophilia present in some cases of JTA, but its relation with clinical course and prognosis is not yet been known. Herein, we report the case of a 24-year-old man diagnosed with concurrent JTA and hypereosinophilic syndrome. We also reviewed the literature of JTA focusing on the impact of combined peripheral eosinophilia on the course of the disease. Combined peripheral eosinophilia may increase the risk of recurrence of JTA after local treatment such as excision only.

Temporal arteritis presenting as hand motor cortex infarction: A report from India

@#This is the first Indian case report of a biopsy proven temporal arteritis that presented as acute ischemic stroke. The 60 year old woman presented with an isolated pure motor flaccid fractional weakness of the left distal hand, as a rare stroke chameleon due to isolated infarction of the ‘hand motor cortex’ area. The hand motor cortex infarction masquerades as ‘pseudoperipheral palsy’.

Bilateral Involvement of Juvenile Temporal Arteritis Associated with Kimura Disease

Juvenile temporal arteritis (JTA) is a localized nodular arteritis confined to the temporal artery without evidence of systemic inflammation, and it occurs mainly in patients younger than 50 years. From the first case report, the pathological features of JTA have been suspected to be the morphological equivalent of Kimura disease (KD), which has been supported further by the concurrent cases of JTA with KD. We present the first case of bilateral JTA accompanying KD, which was confirmed by histological and ultrasound evaluations and supports the hypothesis that JTA is a manifestation of KD. The un-excised JTA lesion was resolved completely after corticosteroid therapy with no recurrence.

The value of 18F-FDG PET/CT in diagnosing giant cell arteritis presenting as fever of unknown origin / 中华内科杂志

Objective To evaluate the clinical diagnostic contribution of 18 F-FDG PET/CT in giant cell arteritis with initial presentation as fever of unknown origin (FUO).Methods Eight cases with initial presentation as FUO diagnosed with the contribution of PET/CT were retrospectively studied in Peking Union Medical College Hospital.The radiologic manifestations of PET/CT were analyzed.Results Eight patients (4 men and 4 women) with average (63 ± 7) years (range from 55-75 years) were included in our study based on the criteria.Non-specific clinical symptoms were common in these patients,including fatigue,night sweat and weight loss.They all suffered from anemia of chronic disease.Not surprisingly,the inflammatory parameters were elevated significantly in all patients.The medical history,physical examination and routine lab and radiologic examinations couldn't reveal the causes of fever.PET/CT was performed in all of them,which demonstrated intense 18F-FDG uptake in the area of aorta and its major branches with maximal standard uptake value (SUVmax) 2.1-4.6 (3.6 ± 0.9).Immunosuppressive agents were effective to control the inflammation activity.The SUV decreased significantly after treatment in the follow-up PET/CT.Conclusions PET/CT has demonstrated high yield of diagnostic contribution in giant cell arteritis with initial presentation as fever of unknown origin.As to elderly FUO patients presenting with prominent inflammatory reaction,PET/CT may provide potential value to differentiate diagnosis from maligancies.

Arteritis temporal en paciente varón de 38 años: reporte de caso y revisión de la literatura / Temporary arteritis in a 38-year-old patient male: report of case and review of the literature

Temporal arteritis, a large vassel vasculitis, particularly in its classical form, is extremely rare in individuals < 50 years. We report a 38 years old male patient that in the context of fever of unknown origin, and after clinical examination, laboratory and imagin analyses get the diagnosis in mention. Been treated with prednisone at 1 mg/kg/d, the therapeutic response was satisfactory. Today, the patient remains asymptomatic...

La arteritis temporal, una forma de vasculitis de vaso grande, particularmente en su forma clásica, es extremadamente rara en individuos < 50 años. Se reporta el caso de un paciente varón de 38 años que, en contexto de Fiebre de Origen Desconocido luego del estudio clínico, laboratorial y de imagenología, llevó al diagnóstico en mención. Al ser tratado con prednisona en dosis de 1 mg/kg/d, la respuesta terapéutica fue satisfactoria. Actualmente se encuentra asintomático...

Arteritis temporal. Revisión de la literatura / Temporal arteritis. A literature review

Introducción: la arteritis temporal constituye una arteritis de células gigantes, la más común en la población en la población mayor de 50 años y usualmente mal diagnosticada. Objetivo: mostrar elementos novedosos en el diagnóstico, presentación clínica, histoquímica y aspectos imagenológicos de la arteritis temporal. Material y Métodos: se realizó una revisión bibliográfica mediante la consulta de bases de datos de los sistemas referativos: MEDLINE, PubMed, Scielo y EBSCO, con la utilización de descriptores como Arteritis temporal, arteritis de células gigantes, diagnóstico, características clínicas y hallazgos imagenológicos. Resultados: es la arteritis de células gigantes más frecuente después de 50 años, etiológicamente asociada a la inmunosenescencia, factores genéticos e infecciones virales; constituyendo la biopsia el elemento pilar en su diagnóstico; empleando en su manejo terapéutico esteroides, inmunosupresores y anticuerpos monoclonales con éxito variable. Conclusiones: la arteritis temporal de células gigantes inmunomediada es una entidad asociada al envejecimiento, con cuadro clínico variado y modificaciones de laboratorio específicas, tratadas por diferentes terapias donde el manejo con glucocorticoides sigue siendo el predominante.

Introduction: the temporal arteritis is a giant cell arteritis, the most common in the population with more than fifty years, and usually are misdiagnosed. Objectiv: to show novel elements in the diagnosis: clinical feature, histochemical aspects, and imagenology of this arteritis. Material and Methods: reference systems such as MEDLINE, PUBMED, SCIELO and ESBCO were consulted. It was also made a revision of descriptors like temporal arteritis, giant cell arteritis, clinical feature, and images findings. Results: is a most common giant cell arteritis in patients with more than fifty years old, associated usually to immunosenescence, genetics factors and viral infections; the biopsy is a main resource in its diagnosis. Steroids, immunosupresors and monoclonal antibodies have been used in its treatment. Conclusions: the temporal arteritis is a immunomediated giant cell arteritis, aging associated, with varied clinical feature and specifics laboratory parameters, treated with different therapies but the steroids therapy is predominant.

A Case of Giant Cell Arteritis Accompanied by Acute Myeloid Leukemia

Giant cell arteritis (GCA), the most common form of systemic vasculitis in adults, preferentially involves large and medium-sized arteries in patients over the age of 50. The classic manifestations are headaches, jaw claudication, polymyalgia rheumatica, and visual symptoms. Acute myeloid leukemia (AML) is a hematopoietic stem cell disorder characterized by a block in the differentiation of hematopoiesis, resulting in the growth of a clonal population of neoplastic cells or blasts. This malignant alteration in hematopoietic stem cells leads to a loss of normal hematopoietic function, which, if left untreated, typically leads to death within weeks to months of its clinical presentation. Although there have been reports of CLL or CML accompanied by several kinds of autoimmune vascular diseases, such as polymyalgia rheumatica, GCA, or necrotizing temporal arteritis, no studies have reported a case of AML with GCA. We experienced an 80-year-old male patient who developed AML 6 years after the diagnosis of GCA. He was under the use of oral glucocorticoid, hydroxychloroquine, and methotrexate at the time of the diagnosis of the AML. This is the first case in Korea to report GCA accompanied by AML.

Temporal arteritis / 中华老年医学杂志

Temporal arteritis,a systemic vasculitis of medium and large arteries that most often occurs in older adults,can cause serious health consequences including blindness if untreated.Clinical features of this condition include headache,polymyalgia,jaw claudication and visual abnormalities (blurred vision,diplopia,transient vision loss,etc).However,the presentations can be atypical and non-specific,leading to delayed or misdiagnosis. Therefore,geriatricians need to be vigilant in recognizing this common rheumatological condition in the elderly.The gold standard for diagnosis of temporal arteritis is temporal artery biopsy.First-line treatment is glucocorticoid steroid.Low dose aspirin appears to be beneficial in preventing cranial ischemic complications. Early treatment can significantly reduce the risk for severe complications including blindness and stroke.

Neurosyphilis Mimicking Temporal Arteritis

No abstract available.

Clinical analysis of 19 cases of giant cell arteritis / 中华全科医师杂志

The clinical data of 19 cases of giant cell arteritis (GCA) including 8 males and 11 females aged 21-92 y (average 62.2 y) from July 2002 to September 2008 were retrospectively reviewed.Among 19 patients,15 first visited the neurology department and 4 the rheumatism department;8 had fever and 16 had headache as primary symptom;the ESR ranged from 20 to 130 mm/1 h (average 71.1 mm/1 h).Fourteen patients were diagnosed as GCA at admission and 18 were treated with steroids hormone and all got remission except 1 death and 2 recurrences.If temporal artery biopsy is not acceptable,integrated analysis of signs,symptoms,laboratory tests,treatment effectiveness and follow-up is important for the correct diagnosis of GCA.

Perirenal hematoma and involvement of the temporal artery in a patient with polyarteritis nodosa (PAN) / Hematoma perirrenal e envolvimento da artéria temporal em paciente com poliarterite nodosa (PAN)

Descrevemos o caso de um paciente masculino, 48 anos, com poliartralgias e mialgias migratórias, associadas a febre e emagrecimento com dois meses de evolução; um episódio de dor testicular bilateral; e cefaleia unilateral pulsátil com espessamento de artéria temporal esquerda sugerindo arterite temporal. Na evolução, o paciente apresentou hematoma perirrenal esquerdo espontâneo, infartos esplênicos e insuficiência renal aguda oligúrica. Foi tratado com prednisona e ciclofosfamida. Foram realizadas biópsias de artéria temporal esquerda e músculo quadríceps. Os achados clínicos, laboratoriais, radiológicos e intercorrências levaram ao diagnóstico de poliarterite nodosa (PAN).

We report the case of a 48-year-old male with a 2-month history of migratory polyarthralgia, and myalgia associated with fever and weight loss; one episode of bilateral testicular pain; and unilateral pulsatile headache with thickening of the left temporal artery suggestive of temporal arteritis. The patient evolved with spontaneous left perirenal hematoma, splenic infarcts, and oliguric acute renal failure. Treatment included prednisone and cyclophosphamide. The left temporal artery and the quadriceps muscle were biopsied. Clinical, laboratorial, and radiological findings, as well as the intercurrences, led to the diagnosis of polyarteritis nodosa.

Granuloma actinico de O'Brien / O'Brien actinic granuloma

Se comunica un caso de granuloma actínico en una paciente de sexo femenino, caucásica, la cual presentaba concomitantemente arteritis de la temporal y polimialgia reumática. Actualmente se considera que debido a la fisiopatogenia de las tres entidades mencionadas, podría tratarse la primera, de un marcador de las dos restantes.

We present a female, white, with an actinic granuloma, concomitantly with temporal arteritis and polymyalgia rheumatica. Today it is considered that, due to the phisiopathogenia of the three entities mentioned before, the first one could be used as a reference for the other two.

Polimialgia reumática: experiencia basada en 22 casos / Polymyalgia rheumatica: experience based on 22 cases

Introducción. La polimialgia reumática (PMR) se caracteriza por dolor y rigidez de las cinturas cervicoescapular y pelviana; preséntase en mayores de 50 años, asociada frecuentemente a arteritis de células gigantes (ACG), y tiene excelente respuesta a dosis bajas de corticosteroides. Objetivo. Evaluar sus características clínicas, de laboratorio, terapéuticas y evolutivas en nuestro medio. Pacientes y método: 22 pacientes diagnosticados según criterios establecidos y controlados entre 1998 y 2008. Según protocolo se analizan sexo, edad, diagnósticos previos, clínica, laboratorio, tratamiento y evolución. Resultados. Edad 52 a 81 años (mediana 69,3); predominio femenino (17/5), y 9,2 meses promedio de evolución prediagnóstico. Todos presentaron dolor y rigidez cervicoescapular y pelviana, 2 pacientes (9 por ciento) tuvieron artritis y 2 (9 por ciento), características clínicas de arteritis de células gigantes (ACG). El laboratorio fue inespecífico, excepto velocidad de sedimentación elevada entre 38 y 131 mm/hora (promedio 80,7). Todos tuvieron factor reumatoídeo (-) y anticuerpos antinucleares (-). Todos, excepto los portadores de ACG, respondieron a dosis bajas de corticosteroides (20 mg/día de prednisona o menos), con dosis de mantención entre 5 y 10 mg/día. Excelente evolución en todos, excepto uno, con desaparición de síntomas, normalización de VHS y reintegración a actividades previas. Conclusiones. La PMR constituye un diagnóstico diferencial en personas mayores de 50 años con dolor de cintura escapular y pelviana, que suele asociarse con ACG. El diagnóstico se basa en criterios bien establecidos, destacando la VHS persistentemente alta y la respuesta a dosis bajas de corticosteroides, que es además la terapéutica de elección.

Polymyalgia rheumatica (PMR) is characterized by cervicoscapular and pelvic pain and rigidity, it manifests in people older than 50 years and is frequently associated with giant cell arteritis (GCA). It responds very well to low doses of corticosteroids. Objective: Evaluate clinical, laboratory, therapeutic and evolutionary characteristics in our environment. Patients and method: 22 patients diagnosed according to set criteria and controlled between 1998 and 2008. Sex, age, previous clinical and laboratory diagnosis, treatment and evolution were analyzed. Results: Age 52 to 81 (average 69.3); 17 females,5 males; and 9.2 month average prediagnostic evolution. All presented cervicoscapular and pelvic pain and rigidity, 2 patients (9 percent) had arthritis, and 2 (9 percent) presentedclinical characteristics of GCA. Laboratory tests were nonspecific, except for high sedimentation speed between 38 and 131 mm/hour (average 80.7). All patients presented rheumatoid factor (-) and antinuclear antibodies (-). All, except GCA carriers, responded to low doses of corticosteroids (20 mg/day or less of Prednisona), followed by a maintenance dose of 5 - 10 mg/day. Evolution was excellent in all patients except one, symptoms disappeared, ESR normalized and patients were reintegrated to their previous activities. Conclusions: PMR constitutes a differential diagnosis in people over 50 years of age, with cervicoscapular and pelvic pain, and is commonly associated with GCA. Diagnosis is based on well established criteria, with persistently high ESR and response to low doses of corticosteroids - the treatment therapy of choice - among the most significant.

Aspectos clínicos da arterite temporal: [revisão] / Clinical aspects of the temporal arteritis: [review]

Introdução: A doença de Horton, ou arterite temporal, é a vasculite sistêmica auto-imune mais comum em adultos, especialmente nos idosos. Objetivo: Realizar uma revisão de literatura sobre os diversos aspectos da doença de Horton, evidenciando as manifestações clínicas otorrinolaringológicas. Método: Foram consultadas as bases de dados on-line EMedicine, Encyclopedia of Medicine, FindArticles, LILACS, MEDLINE, Merck Manuals On-Line Medical Library e SciELO, aplicando à pesquisa os termos: Doença de Horton, Arterite Temporal e Arterite de Células Gigantes, para artigos publicados entre 1996 e 2008. Revisão de Literatura: As manifestações clínicas da doença têm início após os 50 anos de idade, sendo mais freqüentes próximo dos 72 anos. A cefaléia intensa, a tumefação temporal, a claudicação mandibular e o déficit visual são os principais sinais e sintomas. Pode haver ainda disacusia, necrose lingual e odinofagia. Considerações Finais: Múltiplos aspectos da Doença de Horton não têm esclarecimentos devidos e, mesmo sendo uma doença que acomete muitos adultos, não possui investigações profundas em grande quantidade. A melhor compreensão desta levará ao incremento das possibilidades de cura dos pacientes e redução da morbidade, especialmente nas áreas oftalmo e otorrinolaringológica.

Introduction: The Horton's disease, or temporal arteritis, is the most common autoimmune systemic vasculitis in adults, especially the old-aged. Objective: To review the literature about the several aspects of the Horton's disease, and confirm the otorhinolaryngologic clinical manifestations. Method: The study searched online databases such as EMedicine, Encyclopedia of Medicine, FindArticles, LILACS, MEDLINE, Merck Manuals On-Line Medical Library and Scielo, and applied to the search the terms: Horton's disease, Temporal Arteritis and Giant Cells Arteritis, for articles published between 1996 and 2008. Literature's Review: The disease's clinical manifestations start after 50 years old, and it's more frequent near 72 years old. The intense headache, temporal tumefaction, mandibular claudication and visual loss are the main signals and symptoms. There may occur dysacusis, necrosis of the tongue and odynophagia. Considerations: Lots of aspects of the Horton's disease do not have their due elucidation and, even being a disease that affects many adults, it doesn't have deep investigations in great quantity. A better understanding of this disease will lead to the increment of cure possibilities and reduction of morbidity in the patients, especially in ophthalmologic and otorhinolaryngologic areas.

Tos prolongada como manifestación inicial de la arteritis de la temporal / Prolonged cough as initial symptom of temporal arteritis

La tos prolongada puede ser un desafío diagnóstico y terapéutico. Presentamos el caso de un enfermo de 62 años con tos seca y quebrantamiento del estado general durante cuatro semanas, seguido de un síndrome febril prolongado cuyo diagnóstico final fue arteritis de la temporal, con confirmación por anatomía patológica. El dolor en los pabellones auriculares al adoptar el decúbito lateral fue otro síntoma interesante. La tos prolongada puede ser una manifestación inicial de la arteritis temporal en adultos mayores.

Prolonged cough could be a diagnostic and therapeutic dilemma. We present here the case of an elder man who suffered from a dry cough and malaise during four weeks, followed by a fever of unknown origin. After many studies and review of symptoms, a biopsy of the temporal artery confirmed a giant cell arteritis. Cough and malaise could be an early symptom of temporal arteritis in elderly patients. Pain in the outer ear on the lateral decubitus could be another interesting symptom in this disease.

Artritis en el anciano / Arthritis in elderly

Actualmente Colombia vive un cambio en la pirámide poblacional debido al incremento proporcional en sus ancianos, lo cual trae consigo mayor prevalencia de patologías que son importantes en la tercera edad. El envejecimiento conlleva a cambios fisiológicos normales en todos los sistemas, los cuales deben ser comprendidos para el adecuado análisis de la condición de salud de los ancianos. De la misma manera la presentación clínica y de laboratorio varía en el viejo y sumado a esto se presenta mayor comorbilidad y polifarmacia. Por tanto es importante conocer estas variantes en la atención del paciente mayor de 65 años. Las enfermedades reumatológicas no están exentas de lo anterior. La forma de presentación y el curso natural de enfermedades como osteoartritis, enfermedades por depósito de cristales, artritis reumatoide y lupus eritematoso sistémico pueden ser diferentes en los ancianos; además hay enfermedades características de esta edad, como es el caso de la polimialgia reumática, la arteritis de células gigantes y la mayor frecuencia del compromiso articular por cáncer. Se discutirán las manifestaciones clínicas y de laboratorio de estas enfermedades, enfocándose en el adecuado diagnóstico diferencial del compromiso articular en el anciano.

Currently Colombia lives a change in the populational pyramid due to the proportional increment in its elderly people, what lead to a greater prevalence of pathologies that are important in the third age. The aging involve normal physiologic changes in all the systems, which should be understood for the appropriate analysis of the condition of the elderly's health. In the same way the clinical and laboratory presentation varies in the elderly and there is also greater comorbilities and polifarmacy. Therefore it is important to know these variants in the attention of patients older than 65 years. Rheumatologic diseases are not exempt of the above mentioned. The form of presentation and the natural course of diseases like osteoarthritis, crystal-induced arthritis, rheumatoid arthritis and systemic lupus erythematosus can be different in the elderly; there are also characteristic diseases of this age, like polymialgia rheumatica, giant cell arteritis and a greater frequency of articular involvement by cancer. The clinical manifestations and laboratory findings of these diseases will be discussed, focusing in the appropriate differential diagnosis of the articular involvement in the elderly.