Symptomatic lower-limb giant-cell arteritis: Characteristics, management and long-term outcome.

OBJECTIVE: To describe characteristics and long-term outcomes of the rare symptomatic lower-limb giant-cell arteritis (LL-GCA). METHODS: Retrospective analysis of 8 patients (6 women; mean±SD age, 63.6±10.9 years; follow-up, 137.3±57.3 months). RESULTS: Four patients satisfied≥3 American College of Rheumatology (ACR) GCA-classification criteria; 4 had<3 criteria and histological LL-GCA proof or associated typical upper-limb involvement. Patients had 2.1±1.1 vascular risk factors. Bilateral and rapidly progressive arterial claudication was the first LL sign; 2 had rest ischemia. Imaging-visualized most-to-least frequent inflammatory lesion localizations were: superficial femoral, popliteal, tibiofibular trunk, posterior tibial arteries. All received corticosteroids for 132±76.2 months; 2 required immunosuppressive agent adjunction. Only 3 required 1-6 revascularizations: twice during the first month post-diagnosis and twice later. Thromboendarterectomy and endovascular procedures did not work while bypasses were successful. LL-claudication regressed for 7 (10.5±12.1 months) and disappeared for 5 (16.8±9.8 months). Three patients stopped corticosteroids (26-90 months), 1 restarted 45 months later. Every patient relapsed once (23.9±26.7 months, mean corticosteroid dose: 0.28±0.30mg/kg/day). LL-GCA caused only 1 of the 4 deaths. CONCLUSION: Symptomatic LL-GCA attributable long-term mortality seems to be low despite frequent relapses and corticosteroid-dependence.

[Peripheral arterial involvement in giant cell arteritis: how to differentiate between atheroma and inflammation?]. / Atteinte artérielle périphérique dans la maladie de Horton : comment différencier athérome et inflammation ?

Giant cell arteritis (Horton's disease) is an inflammatory arteritis involving medium and large diameter arteries. The disease typically occurs in patients aged 50 years or more who may otherwise have atherothrombotic lesions. It is sometimes difficult to determine whether an arterial stenosis arises from an inflammatory or an atherothrombotic mechanism in a patient with giant cell arteritis. Therefore we describe, through a case report, the clinical features and complementary investigation data helpful for distinguishing between these two entities.

[A negative first-line work-up of Raynaud's phenomenon: And what if it were cancer?]. / Phénomène de Raynaud avec négativité du bilan de première intention : et si c'était un cancer ?

Raynaud's phenomenon is a transient paroxysmal vasomotor phenomenon affecting the extremities including manifestations of ischemia. It is a common phenomenon in the general population. In a routine clinical situation, the first step is to differentiate Raynaud's disease from a secondary Raynaud's phenomenon, the latter requiring complementary investigations. We report here the case of an 80-year-old woman who presented a secondary Raynaud's phenomenon. First-line investigations remained negative. A mammography was performed and revealed breast cancer. Raynaud's phenomenon disappeared after treatment of the breast carcinoma and did not recur during the 2-year follow-up.