Horton’s disease: still an important medical problem in elderly patients: a review and case report

Giant-cell arteritis (GCA) is a systemic inflammatory vasculitis of unknown etiology commonly involving large and medium-sized arteries of the head (cranial arteritis). Horton’s disease is a clinical entity caused by GCA mainly of temporal arteries (temporal arteritis). It is the most common form of systemic vasculitis in adults and elderly persons (arteritis of the aged) and can be an important medical problem resulting in a wide variety of systemic, neurological and ophthalmological complications. Giant-cell arteritis typically affects medium- and large-sized vessels including the superficial temporal arteries, the aorta, the carotid, subclavian and iliac arteries. In addition, the ophthalmic, occipital and vertebral arteries may be affected. The mean age of onset is above 55 years, and it is rare in people aged less than 55 years. Risk factors for manifestation of GCA are age and female sex (women to men ratio is 2 : 1); also a genetic background and infection may play a role in it [1, 2]. The most common symptoms of GCA are results of the involvement of the temporal artery and other medium-sized arteries of the head and the neck; these signs may include the headache, jaw and tongue claudication, tenderness and sensitivity on the scalp, neck pain, acute tinnitus and visual disturbances [3]. For this reason GCA should always be considered in the differential diagnosis of a new-onset headache in patients older than 50 years of age or with an elevated erythrocyte sedimentation rate [4, 5]. General manifestations, such as a moderate fever, vertigo, bruits, fatigue and malaise may also be present [4, 5]. In the physical examination of patients with Horton’s disease, palpation of the head reveals prominent temporal arteries with or without pulsation, tenderness and redness of the temporal area, and even the signs of ischemia might be seen [6]. Laboratory tests may disclose a raised erythrocyte sedimentation rate, elevated platelets count, alkaline phosphatase and C-reactive protein as inflammatory markers [7]. Using radiological examination such as the temporal arteries’ ultrasound, angio-computed tomography or magnetic resonance imaging might be helpful for non-invasive diagnosis of this disorder [8]. Temporal artery biopsy remains the important standard for diagnosis of this vasculitis. Histopathological changes characteristic for the disease are transmural inflammation of the intima, media and adventitia of affected arteries, as well as infiltration by...


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