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G G Hunder

Publications and source records attributed to G G Hunder.

179 records · Page 10Linked to original sources
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Spontaneous remission of Felty's syndrome.

The clinical course of a patient with Felty's syndrome is described. This patient was unusual because during a 3-year period of splenomegaly and leukopenia she did not develop repeated infections, leg ulcers, or other complications of Felty's syndrome. Then a spontaneous remission began. During the subsequent 6 years, neither symptoms nor signs of Felty's syndrome have recurred.

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Case report: Association of giant cell arteritis and pituitary tumor. Report of two cases.

Two patients with giant cell arteritis and visual deficits were found to have pituitary tumors, which accounted for the optic findings. The various ophthalmologic abnormalities in these two conditions, which were apparently coincidentally associated in these two patients, are compared. These cases illustrate the importance of careful neuro-ophthalmologic examination and roentgenograms of the head in patients with giant cell arteritis who have visual field loss.

Adenoma↗
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Classification/diagnostic criteria for GCA/PMR.

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are two common rheumatic diseases occurring in middle-aged and older persons. Their cause is unknown and in neither is there a single specific diagnostic test. As a result a combination of findings is needed for their diagnosis. The American College of Rheumatology has established criteria for the classification of GCA using two methods. These criteria are best used in research studies involving patients with a diagnosis of vasculitis. One method is based on the so-called traditional format. In this method the patient with vasculitis is classified as GCA if he/she manifests any 3 among the list of 5 criteria selected. The second method, the tree format or recursive partitioning method, starts with the clinical finding that best separates patients with GCA from others with vasculitis and then uses other criteria successively to point to a final decision regarding the presence or absence of GCA. Diagnostic criteria for GCA have not been formulated. Diagnostic criteria have been established for PMR by analysis of a series of patients, but in practice most rheumatologists use criteria established informally by consensus.

Giant Cell Arteritis↗
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Clinical features of GCA/PMR.

Giant cell arteritis (GCA) is a common vasculitis of unknown cause that affects persons in middle age and older. Its incidence rises with increasing age. The inflammatory lesions involve larger arteries that contain an abundance of elastic tissue. Although cranial symptoms such as headache, tender scalp, jaw claudication and visual symptoms are common, the disease presents in many different fashions, often with symptoms not directly related to the arteries. These latter presentations include fever, severe malaise, polymyalgia rheumatica, high erythrocyte sedimentation rate and anemia, thrombocytosis, sore throat, and hepatic dysfunction. GCA appears to have a self-limited course, but is also characterized by relapses and recurrences. Visual loss due to occlusion of the optic arteries is the most important early manifestation and aortic aneurysm is the most important late complication. Patients respond promptly to varying doses of glucocorticoids but drug side effects are common.

Giant Cell Arteritis↗
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Polymyalgia manifestations in different conditions mimicking polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) is a generally benign syndrome involving the neck, shoulder, and hip girdles in the elderly. However, none of the clinical and laboratory findings are specific for this syndrome. Different diseases may present with features suggesting PMR. The consideration of other conditions which in some cases resemble PMR is very important, as their therapy and prognosis differ completely from that of PMR. Four patients presenting with typical PMR manifestations, who were finally diagnosed as having conditions very different from PMR, are described. The importance of the differential diagnosis in patients presenting with polymyalgia symptoms is underlined.

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Laboratory investigations useful in giant cell arteritis and Takayasu's arteritis.

A raised erythrocyte sedimentation rate (ESR) is considered a hallmark for the diagnosis of giant cell arteritis (GCA). The American College of Rheumatology 1990 criteria for GCA include ESR greater than or equal to 50 mm/h as one of the five criteria. Although the presence of a normal ESR made GCA less likely, the results of a population-based study showed that the occurrence of a low/normal value in GCA at diagnosis is not rare. Pre-treatment ESR may be a prognostic indicator for duration of treatment. C-reactive protein (CRP) and interleukin-6 (IL-6) may be more sensitive indicators of disease activity than ESR in GCA patients. However, it is unclear whether the use in clinical practice of CRP and IL-6 has some apparent advantage over ESR. ESR is the most often used tool to assess disease activity in Takayasu's arteritis (TA). However, some studies have found that ESR and CRP are not able to differentiate patients with clinically active and inactive TA. Furthermore, histopathological studies have shown that over 40% of patients thought to be in clinical remission with normal acute phase reactants have active arteritis. IL-6 could be a promising marker of disease activity in TA; however, further studies are required to confirm its usefulness in clinical practice. Other laboratory investigations could be useful in the diagnosis or follow-up of GCA and TA, but more studies are required.

Giant Cell Arteritis↗
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Vasculitis of the gallbladder in a 70-year-old man with giant cell (temporal) arteritis.

A patient with giant cell (temporal) arteritis developed acute cholecystitis related to vasculitis. Histopathologically, the vasculitic lesions in the gallbladder resembled polyarteritis nodosa. In addition to demonstrating the rare occurrence of vasculitis of the gallbladder in a patient with giant cell arteritis, this case points out the inadequacies of currently used criteria to separate the various forms of arteritis.

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Bulge sign.

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Humans↗
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HLA-DR locus antigens in polymyalgia rheumatica and giant cell arteritis.

HLA-DR locus antigens were determined in 69 patients with giant cell arteritis, polymyalgia rheumatica, or both. The frequencies of HLA-DR4 and HLA-DRW6 in these patients were increased above normals. But the differences were not significant in the total group nor when the patients were separated according to the presence or absence of polymyalgia rheumatica.

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A follow-up study of polymyalgia rheumatica: evidence of chronic axial synovitis.

A follow-up study of 23 patients with polymyalgia rheumatica 3.2 yr after onset and 2.6 yr after diagnosis showed that (1) 15 of 16 still had abnormal joint scans; (2) 18 of 23 still needed antiinflammatory drugs; (3) 16 of 23 believed they still had the disease; (4) erythrocyte sedimentation rates were persistently elevated beyond the 90th percentile in 11 patients (47%); and (5) 7 of 18 patients with available roentgenograms had joint abnormalities. We suggest that polymyalgia rheumatica is a chronic arthritis affecting primarily the proximal joints.

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