Tegiex
a r t i c l e
i n f o
Article history:
Teceiged 6 Cpsil 200:
Cccepued 7 Oaz 200:
Keywords:
Csuesiuit
Iianu cell
Vemposal
a b s t r a c t
Iianu cell asuesiuit (IEC) it an immvne-mediaued gatcvliuit affecuing indigidvalt oges 60 zeast of age. Ku it
chasacuesited bz gsanvlomauovt inflammauion uhau affecut medivm-tized and lasge asuesiet. Vhe xide
tpecusvm of clinical manifetuauiont can be digided inuo uhote selaued uo uittve itchemia fsom gatcvlas
letiont and uhote selaued uo a tztuemic inflammauosz setponte. Vhe pauhogenetit of uhete gsovpt alto
appeast dituincu, xiuh gatcvlas letion fosmauion uhovghu uo be an adapuige immvne setponte, and uhe tztuemic inflammauosz seacuion an innaue immvne setponte. Elinical tvtpicion of IEC mvtu semain etpeciallz high in uhote xiuh nevsological os gitval tzmpuomt and if xassanued, psompu useaumenu xiuh
high-dote cosuicotuesoidt it ingalvable in haluing diteate psogsettion.
200: Gltegies Nud. Cll sighut setesged.
1. Introduction
Iianu cell asuesiuit (IEC), alto knoxn at uemposal asuesiuit os
gsanvlomauovt asuesiuit, it a tztuemic inflammauosz gatcvliuit uhau
affecut medivm-tized uo lasge asuesiet. Csuesial xall inflammauion
leadt uo lvminal occlvtion and uittve itchemia, xhich cavte uhe
clinical manifetuauiont of uhit gatcvliuit. Uvtcepuible tiuet inclvde;
uhe gatcvlas bed of uhe csanial nesget, opuic nesge, matteues mvtclet, and uhe potuesios ciscvlauion of uhe cenusal nesgovt tztuem.
Kngolgemenu can eyuend uo uhe aosua and iut psimasz and tecondasz
bsanchet, inclvding uhe tvbclagian and ayillasz asuesiet, xhich
leadt uo vppes-eyusemiuz itchemia.
C clotelz selaued enuiuz, polzmzalgia shevmauica, it a tztuemic
inflammauosz diteate uhau manifetut at mzalgiat of uhe neck,
thovldes, and pelgic gisdle. Iianu-cell asuesiuit and polzmzalgia
shevmauica fservenulz occvs uogeuhes in uhe tame pauienu. Yheseat
uhe diagnotit of gianu-cell asuesiuit can be psogen bz uemposal asuesz bioptz, no pauhognomonic uetu it agailable fos polzmzalgia
shevmauica.
Xition lott it a fservenu complicauion of IEC, and once iu occvst
iu uendt uo be bouh pesmanenu and psofovnd. Vhit it uzpicallz uhe
setvlu of asuesiuic anuesios itchemic opuic nevsopauhz (CCKQP), an
infascuion of uhe opuic nesge head tecondasz uo inflammauion of
uhe xall of uhe potuesios ciliasz asuesiet.
2. Epidemiology
Iianu cell asuesiuit it uhe motu fservenu psimasz gatcvliuit,1 psedominanulz affecuing Eavcatian people2 oges 60 zeast of age, xiuh
* Eossetponding avuhos. Vel.; +75 : 383 86::y97265.
E-mail address: h.danethmezesBavckland.ac.nz (J.X. Faneth-Oezes).
0:78-6979/$ - tee fsonu mauues 200: Gltegies Nud. Cll sighut setesged.
doi;10.1017/j.jocn.200:.06.002
xomen affecued au leatu uxice at ofuen at men.3 Kut ogesall incidence it 16 uo 26 pes 100 000/zeas in indigidvalt oges uhe age of
60 zeast;5 hoxeges, incidence incseatet xiuh age; fsom 2.3 pes
100 000/zeas among pauienut in uheis tiyuh decade of life, uo 55.8
pes 100 000/zeas among pauienut in uheis ninuh decade and oldes.6,7
IEC it mose fservenu among people of Ucandinagian and Posuhesn
Gvsopean detcenu, issetpecuige of uheis place of setidence.79 Vhit,
along xiuh seposut of concosdance xiuh monozzgouic uxint: and
familial clvtuesing,10 tvggetut an inhesiued componenu uo uhe
diteate.
Uome tuvdiet hage fovnd an attociauion xiuh JNC-FT5 haplouzpe and 70% of pauienut eypsett uhe D1*0501 os D1*0505/9 gasianu
of uhe JNC-FT5 haplouzpe.11 Vhete allelet appeas uo be a tusong
sitk facuos fos diteate and a maskes fos tuesoid setituance in tome
popvlauiont.12 Vhe inuescellvlas adhetion molecvle 1 (KECO-1)
genet maz alto pseditpote uo IEC.13 KECO-1 it tusonglz eypsetted
in uhe inflammauosz infilusaue of uhe uemposal asuesz in IEC and I/
T 251 polzmosphitmt in uhe KECO-1 gene ase attociaued xiuh IEC
tvtcepuibiliuz.13
3. Clinical features
IEC hat a xide tpecusvm of clinical manifetuauiont selaued uo
eiuhes uittve itchemia fsom gatcvlas letiont, os tztuemic inflammauion. Fve uo uhe xide tpecusvm of tzmpuomt, pauienut maz nou
tponuaneovtlz offes uhe necettasz infosmauion, making disecu and
tpecific rvetuioning impesauige xhen uhese it tvtpicion of IEC.
3.1. Medium-vessel symptoms
Csuesiuit ofuen occvst in uhe casouid asuesiet and uheis bsanchet,
tvch at uhe tvpesficial uemposal, occipiual, ophuhalmic, potuesios
1275
ciliasz and gesuebsal asuesiet. Jeadachet uhau ase nex and tegese
ase uhvt common in uxo-uhisdt of pauienut. Vheis locauion it chasacuesituicallz uemposal, aluhovgh uhez maz be fsonual, pasieual, os
occipiual.15 Ucalp uendesnett, os disecu uemposal asuesz uendesnett,
thovld alto heighuen tvtpicion of IEC and pauienut ofuen seposu
pain attociaued xiuh bsvthing uheis hais. Lax clavdicauion, selaued
uo sedvced blood flox uo uhe matteues and uemposalit mvtclet, it
highlz tpecific fos IEC and it detcsibed at a csamping uhau incseatet xiuh conuinved matuicauion os tpeech uhau it selieged bz
setu of uhete mvtclet.16 Ease mvtu be uaken uo diffesenuiaue jax
clavdicauion fsom ouhes cavtet of uemposomandibvlas joinu ditcomfosu uhau ase nou itchemic in osigin. Nett fservenu ase tzmpuomt selaued uo itchemia of uhe uongve, face os neck.17
Table 1
Qcvlas tzmpuomt and cavtet of gitval lott in 96 pauienut xiuh gianu cell asuesiuit
(Cdapued fsom Jazseh eu al.30)
Uzmpuomt/cavtet
Symptoms
1. Cmavsotit fvgay
2. Xitval lott
3. Fiplopia
5. Gze pain
Causes
1. Cnuesios itchemic opuic nevsopauhz
2. Eenusal seuinal asuesz occlvtion
3. Eilioseuinal asuesz occlvtion
5. Rotuesios itchemic opuic nevsopauhz
Rsetence (%)
30.7
:7.:
6.:
9.2
91.1
15.1
21.9
8.1
1276
3.6.3. Diplopia
Ktchemia of eyusaocvlas mvtclet, ocvlas mouos nesget os uhe
bsaintuem maz be setpontible fos diplopia and ocvlas mouos imbalance, usantienu os contuanu, in 2% uo 16% of IEC pauienut. Vhe occvlomouos (KKK) nesge it uhovghu uo be motu commonlz ingolged, ofuen
tpasing uhe pvpil; hoxeges, ingolgemenu of uhe usochleas (KX) and
abdvcent (XK) nesget hat been seposued.30,56
Vhese it no tingle clinical tzmpuom, tign os labosauosz uetu tpecific fos IEC.16 Kn 1::0, uhe Cmesican Eollege of Thevmauologz
(CET) fosmvlaued clattificauion csiuesia uhau xese effecuige in dituingvithing IEC fsom ouhes fosmt of gatcvliuit (Vable 2). Kn a pauienu xiuh a diagnotit of tome fosm of gatcvliuit, uhe psetence of
uhsee of uhe fige csiuesia xat deemed uo be :5% tentiuige and :1%
tpecific fos uhe diagnotit of IEC.77 Vhe CET did nou hoxeges, uake
inuo accovnu ouhes imposuanu facuost tvch at gitval tzmpuomt, jax
clavdicauion, neck pain and saited E-seacuige psouein.
Yhile uhe eyacu euiologz of IEC it vnknoxn, a gasieuz of infecuiovt agenut hage been tvggetued at pouenuial immvne usiggest fos
uhe diteate, inclvding hespet gisvt, pasainflvenza gisvt, czuomegalogisvt, pasgogisvt D1:, chlamzdia and mzcoplatma.575: Vhese it
liuule dovbu uhau immvne-mediaued psocettet facuos in uhe pauhogenetit of IEC, and bouh uhe adapuige and innaue immvne tztuemt
hage been implicaued.60
Glegauion of uhe eszuhsoczue tedimenuauion saue (GUT) it a nontpecific indicauos of inflammauion and it incseated in malignancz,
infecuion, connecuige uittve ditosdest, usavma, anemia and hzpescholetuesolemia. Yhile a tignificanu elegauion of uhe GUT it ofuen
psetenu in IEC, iu maz be nosmal in vp uo 18% of diagnoted catet,
and uhvt cannou be vted uo eyclvde IEC.78 Vhe vppes limiu fos a
nosmal GUT it uhovghu uo incseate xiuh age and hat been defined
at uhe age digided bz uxo fos men, and uhe age plvt 10 digided
bz 2 fos xomen.79 Kn motu IEC pauienut xiuh GUT elegauion, iu
can be vted accvsauelz uo moniuos diteate acuigiuz.7:
tpecificiuz of vp uo :8.6% in pauienut xiuh IEC, and maz be elegaued in uhe psetence of a nosmal GUT.80 Yhile iu it mose tentiuige
uhan an elegaued GUT (8797%), xhen bouh uetut ase vted in conjvncuion, uhe tentiuigiuz it incseated uo oges ::%.80 Kn conusatu uo
GUT, ETR hat an accvsauelz defined nosmal sange (>6 mg/N) uhau
doet nou gasz xiuh age os tey, and iut vte in diteate moniuosing
it lett xell docvmenued.
6.3. Full blood count
Vhsomboczuotit hat been potiuigelz cosselaued xiuh bioptz-psogen IEC and semaint an imposuanu maskes fos IEC.81,82 Kn facu, an
elegaued plaueleu covnu (@500 103/N) maz be egen mose tpecific
uhan bouh GUT and ETR in uhe diagnotit of IEC.83 Cbovu 20% uo
60% of pauienut xiuh IEC xill alto hage a nosmoczuic nosmochsomic anaemia.85
6.4. Other laboratory tests
Glegaued platma gitcotiuz, fibsinogen, complemenu, inueslevkin7 (KN-7) and a2-and b-globvlint hage been fovnd in IEC.86,87 KN-7
maz be mose tentiuige uhan GUT in indicauing diteate acuigiuz.88
Cbnosmal liges fvncuion uetut, in pasuicvlas saited alkaline photphauate, maz occvs in vp uo one half of pauienut xiuh IEC.89
Cnui-casdiolipin anuibodiet ase ofuen saited in IEC and dvsing selaptet. Wnlike GUT and ETR, uhez do nou incseate in non-IEC-attociaued inflammauion.8:
6.5. Temporal artery biopsy
Vemposal asuesz bioptz (VCD) it uhe gold tuandasd fos uhe diagnotit of IEC and thovld be pesfosmed on all pauienut in xhom uhe
diagnotit of IEC it tvtpecued. Jituological confismauion it secommended tince long-uesm cosuicotuesoid useaumenu it nou xiuhovu
complicauiont.90 Joxeges, osganitauion of uhe VCD thovld neges
delaz uhe intuigauion of useaumenu. Qpuimallz, VCD thovld be pesfosmed xiuhin one xeek of iniuiauing tztuemic cosuicotuesoidt;
hoxeges, hituological egidence semaint vp uo tiy xeekt folloxing
useaumenu.91 Vo agoid a falte negauige setvlu dve uo tkip letiont, a
minimvm lenguh of 20 mm thovld be obuained. Ku thovld be
semembesed uhau uhe uemposal asuesz can conusacu tvbtuanuiallz
afues eycition and befose uittve fiyauion.92 Kn tuvdz of 38 negauige
and 8 potiuige bioptiet fos IEC uhe mean conusacuion xat 12%
fos potiuige tpeciment and 22% fos negauige tpeciment.92 Qgesall
uhe tentiuigiuz of VCD it 98%.93 Kf uhe VCD setvlu it negauige and
uhe tvtpicion of IEC it high, a conusalauesal VCD thovld be
pesfosmed.93
6.6. Other investigations
Hlvosetcein angiogsaphz it vtefvl in pauienut xiuh ocvlas IEC.
Rsolonged chosoidal and cenusal seuinal asuesial filling uimet, and
chosoidal non-pesfvtion os filling defecut ase tvggetuige of
CCKQP.95 Wlusatonogsaphz of affecued asuesiet it a vtefvl non-ingatige uechnirve uo deuecu changet in uhe asuesial xall attociaued
xiuh IEC, changet in osbiual blood flox, os uo usack uhe asuesial
covste psios uo bioptz.96
OTK and potiuson emittion uomogsaphz (RGV) tcanning hage
been vted tvccettfvllz uo diagnote lasge-gettel gatcvliuit and
aosuiuit.97,98
7. Treatment
Vhe goal of useaumenu it uo psegenu ongoing itchemic damage
uo ouhes osgant in uhe bodz. Kn pasuicvlas, if uhe gitval lott it
Uztuemic cosuicotuesoidt ase uhe maintuaz of useaumenu. Jighdote cosuicotuesoid useaumenu psogidet anuioyidanu and gatodilauosz effecut on uop of uheis anui-inflammauosz effecut.99 Fetpiue uhit,
iu it xell secognited uhau psogsettige gitval lott maz occvs detpiue
uhe easlz intuiuvuion of high-dote cosuicotuesoidde8Vm
[(Kndhetti2(eff%:j
07.0):
7.4. Aspirin
Vhsombotit tecondasz uo inflammauion, inuimal hzpesplatia and
tuenotit mighu be a majos conusibvuos uo itchemic complicauiont. C
seusotpecuige tuvdz of pauienut xiuh IEC fovnd uhau ogesall 11 of
79 pauienut (17.2%) had an itchemic egenu xhile seceiging anuiplaueleu os anuicoagvlanu uhesapz compased uo 37 of 86 pauienut
(59.0%) nou seceiging tvch uhesapz (p > 0.0006).:7 Po incseate in
hemosshagic complicauiont xat teen.:7 Vhe avuhost conclvded
uhau anuiplaueleu agenut maz sedvce uhe sitk of itchemic egenu in
IEC; hoxeges, fvsuhes tuvdiet ase needed.
7.5. Other treatments
Czauhiopsine, czclophotphamide, daptone and czclotposine
hage been tvggetued at pottible cosuicotuesoid tpasing agenut,
aluhovgh uhese ase no conclvtige daua au uhit uime.:8::
8. Prognosis
Eavtet of mosualiuz attociaued xiuh IEC inclvde casdiogatcvlas,
nevsological and gatusoinuetuinal egenut. Xatcvliuit of uhe cosonasz
asuesiet maz setvlu in mzocasdial infascuion os congetuige heasu
failvse.100 Cosuic anevsztm svpuvse os aosuic dittecuion it pottible.
Ktchemic bsain damage it uhe tecond motu common cavte of IECselaued deauh afues casdiac diteate.101 Vhit maz occvs bz eiuhes
inflammauosz obtusvcuion of uhe gesuebsobatilas os casouid asuesial
tztuemt, embolitm os psopagauion of uhsombvt fsom inflamed
asuesiet uo vninflamed asuesiet. Pecsouizing tegmenut of boxel
ase vncommon, bvu can alto be faual.
Vhe psognotit fos gitval secogesz it poos folloxing IEC.
Cluhovgh impsogemenu in gitval acviuz hat been seposued in a
tmall minosiuz of pauienut,33 uhit it likelz tecondasz uo eccenusic
fiyauion os leasning cvsge sauhes uhan usve impsogemenu in vtefvl
gition. Hvsuhesmose, gitval deuesiosauion occvst in abovu 28% of
ezet detpiue high-dote inusagenovt meuhzlpsednitolone.37 Vhe
gseauetu sitk of gitval deuesiosauion it in uhe fistu tiy dazt.37 Joxeges, useaumenu xiuh inusagenovt cosuicotuesoidt it effecuige in
sedvcing uhe likelihood of fellox eze ingolgemenu.31 Yiuhovu useaumenu uhe sitk of fellox eze ingolgemenu it 65% uo :6%.31
9. Conclusion
Iianu cell asuesiuit it a tztuemic gatcvliuit xiuh a xide clinical
tpecusvm, inclvding tignificanu nevsological and ocvlas manifetuauiont uhau hage degatuauing contervencet. Reshapt one of uhe motu
tignificanu it gition lott tecondasz uo CCKQP. Eliniciant mvtu uhesefose hage a high indey of tvtpicion fos IEC, etpeciallz in uhe teuuing of vneyplained gitval os nevsological tzmpuomt. Cluhovgh
uhese it no tingle labosauosz uetu uhau etuablithet uhe diagnotit,
uhe psetence of uittve itchemic and tztuemic tzmpuomt in attociauion xiuh elegaued inflammauosz maskest tvch at GUT and ETR ase
tignificanu csiuesia uhau thovld be vted fos easlz deuecuion and
psompu useaumenu xiuh high-dote cosuicotuesoidt. Uince uhit line
of useaumenu it nou xiuhovu tignificanu complicauiont, bioptz confismauion it ettenuial xhese pottible. Hvuvse seteasch xill no dovbu
be focvted au degeloping nex cosuicotuesoid-tpasing useaumenu
modaliuiet.
References
1. Naxsence TE, Jelmick EI, Csneuu HE, eu al. Gtuimauet of uhe psegalence of
asuhsiuit and telecued mvtcvlotkeleual ditosdest in uhe Wniued Uuauet. Arthritis
Rheum 1::9;41;889::.
2. Umiuh Easolzn C, Hidles YL, Rinalt TU. Vhe epidemiologz of gianu cell asuesiuit.
Teposu of a uen-zeas tuvdz in Uhelbz Eovnuz, Vennettee. Arthritis Rheum
1:93;26;1215:.
1278
3. Oachado GDX, Oicheu EL, Dallasd FL, eu al. Vsendt in incidence and clinical
psetenuauion of uemposal asuesiuit in Qlmtued Eovnuz, Oinnetoua, 1:601:96.
Arthritis Rheum 1:99;31;856:.
5. Jvndes II. Gpidemiologz of gianu-cell asuesiuit. Cleve Clin J Med
2002;69;UKK8:=0A@UKK92.
6. Dengutton DC, Oalmgall DG. Vhe epidemiologz of gianu cell asuesiuit inclvding
uemposal asuesiuit and polzmzalgia shevmauica. Kncidencet of diffesenu clinical
psetenuauiont and eze complicauiont. Arthritis Rheum 1:91;24;9:::05.
7. Oachado GD, Oicheu EL, Dallasd FL, eu al. Vsendt in incidence and clinical
psetenuauion of uemposal asuesiuit in Qlmtued Eovnuz, Oinnetoua, 1:601:96.
Arthritis Rheum 1:99;31;856:.
8. Daldvstton Q, Uueintton M, Djosntton L, eu al. Iianu cell asuesiuit in Kceland. Cn
epidemiologic and hituopauhologic analztit. Arthritis Rheum 1::5;37;100812.
9. Isan LV, Ozklebvtu I. Vhe incidence of polzmzalgia shevmauica and uemposal
asuesiuit in uhe covnuz of Cvtu Cgdes, tovuh Posxaz; a psotpecuige tuvdz 1:98
:5. J Rheumatol 1::8;24;183:53.
:. Memp C. Oonozzgouic uxint xiuh uemposal asuesiuit and ophuhalmic asuesiuit.
Acta Ophthalmol (Copenh) 1:88;55;193:0.
10. Yesnick T, Fagez O, Donafede R. Hamilial gianu cell asuesiuit; seposu of an JNCuzped tibling pais and a segiex of uhe liuesauvse. Clin Exp Rheumatol
1::5;12;737.
11. Dassies L, Dignon LF, Uovlillov LR, eu al. Kncseated psegalence of JNC-FT5 in
gianu-cell asuesiuit. N Engl J Med 1:91;305;1056.
12. Yezand EO, Jicok ME, Jvndes II, eu al. Vhe JNC-FTD1 locvt at a geneuic
componenu in gianu cell asuesiuit. Oapping of a diteate-linked tervence mouif
uo uhe anuigen binding tiue of uhe JNC-FT molecvle. J Clin Invest
1::2;90;236671.
13. Ualgasani E, Eatali D, Doiasdi N, eu al. Knuescellvlas adhetion molecvle 1 gene
polzmosphitmt in polzmzalgia shevmauica/gianu cell asuesiuit; attociauion
xiuh diteate sitk and tegesiuz. J Rheumatol 2000;27;121621.
15. Jazseh UU, Rodhajtkz RC, Taman T, eu al. Iianu cell asuesiuit; galidiuz and
seliabiliuz of gasiovt diagnotuic csiuesia. Am J Ophthalmol 1::8;123;296:7.
16. Umeuana IY, Uhmesling TJ. Foet uhit pauienu hage uemposal asuesiuitA JAMA
2002;287;:2101.
17. OcFonnell RL, Ooose IY, Oilles PT, eu al. Vemposal asuesiuit. C
clinicopauhologic tuvdz. Ophthalmology 1:97;93;61930.
18. Dsack C, Oasuinez-Vaboada X, Uuanton C, eu al. Fiteate pauuesn in csanial and
lasge-gettel gianu cell asuesiuit. Arthritis Rheum 1:::;42;3118.
19. Mlein TI, Jvndes II, Uuanton CY, eu al. Nasge asuesz ingolgemenu in gianu cell
(uemposal) asuesiuit. Ann Intern Med 1:86;83;90712.
1:. Ggant LO, QHallon YO, Jvndes II. Kncseated incidence of aosuic anevsztm
and dittecuion in gianu cell (uemposal) asuesiuit. C popvlauion-bated tuvdz. Ann
Intern Med 1::6;122;6028.
20. Ealamia MV, Jvndes II. Iianu cell asuesiuit (uemposal asuesiuit) psetenuing at
feges of vndeuesmined osigin. Arthritis Rheum 1:91;24;15159.
21. Ualgasani E, Eanuini H, Jvndes II. Rolzmzalgia shevmauica and gianu-cell
asuesiuit. Lancet 2009;372;23556.
22. Umeeuh N, Eook E, Jall CL. Kncidence of diagnoted polzmzalgia shevmauica and
uemposal asuesiuit in uhe Wniued Mingdom, 1::02001. Ann Rheum Dis
2007;65;10:39.
23. Ualgasani E, Eanuini H, Doiasdi N, eu al. Rolzmzalgia shevmauica and gianu-cell
asuesiuit. N Engl J Med 2002;347;27181.
25. Eatelli TL, Favbe LT, Jvndes II, eu al. Resiphesal nevsopauhic tzndsomet in
gianu cell (uemposal) asuesiuit. Neurology 1:99;38;796:.
26. Eatelli TL, Jvndes II, Yhitnanu LR. Pevsologic diteate in bioptz-psogen gianu
cell (uemposal) asuesiuit. Neurology 1:99;38;362:.
27. Ionzalez-Iaz OC, Dlanco T, Todsigvez-Xalgesde X, eu al. Resmanenu gitval
lott and cesebsogatcvlas accidenut in gianu cell asuesiuit; psedicuost and
setponte uo useaumenu. Arthritis Rheum 1::9;41;15:8605.
28. Ualgasani E, Iiannini E, Oilles FX, eu al. Iianu cell asuesiuit; Kngolgemenu of
inusacsanial asuesiet. Arthritis Rheum 2007;55;:96:.
29. Jvtuon MC, Jvndes II, Nie LV, eu al. Vemposal asuesiuit; a 26-zeas
epidemiologic, clinical, and pauhologic tuvdz. Ann Intern Med 1:89;88;1728.
2:. Lonatton H, Evllen LH, Gluon TC. Vemposal asuesiuit. C 15-zeas epidemiological,
clinical and psognotuic tuvdz. Scott Med J 1:8:;24;1118.
30. Jazseh UU, Rodhajtkz RC, Zimmesman D. Qcvlas manifetuauiont of gianu cell
asuesiuit. Am J Ophthalmol 1::9;125;60:20.
31. Niv IV, Ilates LU, Uchauz PL, eu al. Xitval mosbidiuz in gianu cell asuesiuit.
Elinical chasacuesituict and psognotit fos gition. Ophthalmology
1::5;101;188:96.
32. Eosnblauh YV, Gggenbesges GT. Rsogsettige gitval lott fsom gianu cell asuesiuit
detpiue
high-dote
inusagenovt
meuhzlpsednitolone.
Ophthalmology
1::8;104;9659.
33. Hosoozan T, Fesamo XC, Dvono NO, eu al. Tecogesz of gitval fvncuion in
pauienut xiuh bioptz-psogen gianu cell asuesiuit. Ophthalmology
2003;110;63:52.
35. Jazseh UU, Zimmesman D. Xitval field abnosmaliuiet in nonasuesiuic anuesios
itchemic opuic nevsopauhz; uheis pauuesn and psegalence au iniuial
eyaminauion. Arch Ophthalmol 2006;123;166572.
36. Tepka OZ, Uagino RL, Uchauz PL, eu al. Elinical psofile and long-uesm
implicauiont of anuesios itchemic opuic nevsopauhz. Am J Ophthalmol
1:93;96;58993.
37. Faneth-Oezes J, Uagino RL, Iamble II. Roos psognotit of gitval ovucome
afues gitval lott fsom gianu cell asuesiuit. Ophthalmology 2006;112;10:9103.
38. Jenkind R, Ehaslet PE, Reaston L. Jituopauhologz of itchemic opuic
nevsopauhz. Am J Ophthalmol 1:80;69;89:0.
1279
80. Rasikh O, Oilles PT, Nee CI, eu al. Rsegalence of a nosmal E-seacuige psouein
xiuh an elegaued eszuhsoczue tedimenuauion saue in bioptz-psogen gianu cell
asuesiuit. Ophthalmology 2007;113;19526.
81. Msithna T, Motmostkz IU. Kmplicauiont of uhsomboczuotit in gianu cell asuesiuit.
Am J Ophthalmol 1::8;124;103.
82. Rsice P, Eleaskin NI. Vhsomboczuotit and gianu cell asuesiuit. Lancet
1::5;343;782.
83. Hosoozan T, Faneth-Oezes J, Uagino RL, eu al. Vhsomboczuotit in pauienut xiuh
bioptz-psogen gianu cell asuesiuit. Ophthalmology 2002;109;127881.
85. Yeitt NO, Ionzalez G, Oilles UD, eu al. Uegese anemia at uhe psetenuing
manifetuauion of gianu cell asuesiuit. Arthritis Rheum 1::6;38;5357.
86. Dsiuuain IR, OcKlxaine II, Dell LC, eu al. Rlatma gitcotiuz os eszuhsoczue
tedimenuauion saue in uhe diagnotit of gianu cell asuesiuitA Br J Ophthalmol
1::1;75;767:.
87. gon Mnossing L. Vseaumenu and psognotit in polzmzalgia shevmauica and
uemposal asuesiuit. C uen-zeas tvsgez of 63 pauienut. Acta Med Scand
1:8:;205;52:36.
88. Yezand EO, Hvlbsighu LY, Jvndes II, eu al. Vseaumenu of gianu cell asuesiuit;
inueslevkin-7 at a biologic maskes of diteate acuigiuz. Arthritis Rheum
2000;43;10519.
89. Gtpinota I, Vattiet F, Honu L, eu al. Cnuiphotpholipid anuibodiet and
uhsombophilic facuost in gianu cell asuesiuit. Semin Arthritis Rheum
2001;31;1220.
8:. Niozon G, Toblou R, Raise F, eu al. Cnuicasdiolipin anuibodz legelt psedicu flaset
and selaptet in pauienut xiuh gianu-cell (uemposal) asuesiuit. C longiuvdinal
tuvdz of 69 bioptz-psogen catet. Rheumatology (Oxford) 2000;39;109::5.
90. Jvtuon MC, Jvndes II. Iianu cell (csanial) asuesiuit; a clinical segiex. Am
Heart J 1:90;100;::106.
91. Taz-Ehavdhvsi P, Mine FC, Vijani UQ, eu al. Gffecu of psios tuesoid useaumenu on
uemposal asuesz bioptz findingt in gianu cell asuesiuit. Br J Ophthalmol
2002;86;6302.
92. Uv IY, Hosoozan T, Yen OV. Svanuiuauige analztit of uemposal asuesz
conusacuion afues bioptz fos egalvauion of gianu cell asuesiuit. Can J
Ophthalmol 2007;41;6003.
93. Piedeskohs TF, Negin NC. Oanagemenu of uhe pauienu xiuh tvtpecued uemposal
asuesiuit a decition-analzuic appsoach. Ophthalmology 2006;112;85567.
95. Uiaukoxtki TO, Iatt LF, Ilates LU, eu al. Hlvosetcein angiogsaphz in uhe
diagnotit of gianu cell asuesiuit. Am J Ophthalmol 1::3;115;6873.
96. Jvndes II, Yezand EO. Uonogsaphz in gianu-cell asuesiuit. N Engl J Med
1::8;337;13967.
97. Cualaz OM, Dlvemke FC. Oagneuic setonance imaging of lasge gettel
gatcvliuit. Curr Opin Rheumatol 2001;13;518.
98. de Neevx M, Dijl O, Lages RN. Cddiuional galve of potiuson emittion uomogsaphz
in diagnotit and follox-vp of pauienut xiuh lasge gettel gatcvliuidet. Clin Exp
Rheumatol 2005;22;U217.
99. Jall GF. Jigh-dote glvcocosuicoid useaumenu impsoget nevsological secogesz
in head-injvsed mice. J Neurosurg 1:96;62;9928.
9:. Jazseh UU, Zimmesman D. Xitval deuesiosauion in gianu cell asuesiuit pauienut
xhile on high dotet of cosuicotuesoid uhesapz. Ophthalmology
2003;110;120516.
:0. Rsogen C, Iabsiel UG, Qscet E, eu al. Ilvcocosuicoid uhesapz in gianu cell
asuesiuit; dvsauion and adgeste ovucomet. Arthritis Rheum 2003;49;8039.
:1. Ioodman Ls DY. Vemposal asuesiuit. Am J Med 1:8:;67;93:62.
:2. Jesnandez-Todsigvez L, Iascia-Oasuinez C, Eatademonu L, eu al. C tusong iniuial
tztuemic inflammauosz setponte it attociaued xiuh highes cosuicotuesoid
servisemenut and longes dvsauion of uhesapz in pauienut xiuh gianu-cell
asuesiuit. Arthritis Rheum 2002;47;2:36.
:3. Joffman IU, Eid OE, Jellmann FD, eu al. C mvluicenues, sandomized, dovbleblind, placebo-conusolled usial of adjvganu meuhouseyaue useaumenu fos gianu
cell asuesiuit. Arthritis Rheum 2002;46;130:19.
:5. Upiesa TH, Oiunick JL, Mvpestmiuh O, eu al. C psotpecuige, dovble-blind,
sandomized, placebo conusolled usial of meuhouseyaue in uhe useaumenu of gianu
cell asuesiuit (IEC). Clin Exp Rheumatol 2001;19;5:6601.
:6. Joffman IU, Eid OE, Tendu-Zagas MG, eu al. Knfliyimab fos mainuenance of
glvcocosuicotuesoid-indvced semittion of gianu cell asuesiuit; a sandomized
usial. Ann Intern Med 2008;146;72130.
:7. Nee OU, Umiuh UF, Ialos C, eu al. Cnuiplaueleu and anuicoagvlanu uhesapz in
pauienut xiuh gianu cell asuesiuit. Arthritis Rheum 2007;54;3307:.
:8. Pethes I, Uonnenblick O. Uuesoid-tpasing medicauiont in uemposal asuesiuit
seposu of uhsee catet and segiex of 185 seposued pauienut. Clin Rheumatol
1::5;13;29::2.
:9. Fe Uilga O, Jazleman DN. Czauhiopsine in gianu cell asuesiuit/polzmzalgia
shevmauica; a dovble-blind tuvdz. Ann Rheum Dis 1:97;45;1379.
::. Pvenninghoff FO, Oauueton GN. Vhe sole of diteate-modifzing anuishevmauic
dsvgt in uhe useaumenu of gianu cell asuesiuit. Clin Exp Rheumatol
2003;21;U2:35.
100. Oossit ET, Ucheib LU. Haual mzocasdial infascuion setvluing fsom cosonasz
asuesiuit in a pauienu xiuh polzmzalgia shevmauica and bioptz-psoged
uemposal asuesiuit. C cate seposu and segiex of uhe liuesauvse. Arch Intern
Med 1::5;154;116970.
101. Jvndes II. Iianu cell asuesiuit and polzmzalgia shevmauica. Kn; Mellez YP,
Jassit GF, Tvddz U, ediuost. Textbook of Rheumatology. 5uh ed. Rhiladelphia,
RC; Y.D. Uavndest; 1::3. p. 110312.