Reduction of jaw opening (trismus) in giant cell arteritis. (Concise Report).

Ann Rheum Dis 2002;61:832-833

Objective: To study the prevalence and the clinical characterisation of jaw problems in patients with giant cell arteritis (GCA).

Methods: the prevalence of such symptoms in patients with GCA was evaluated by performing a retrospective analysis of all patients with GCA and polymyalgia rheumatica who were diagnosed during admission to Hadassah University Hospital. Ten patients reported previously in the Jiterature were also evaluated.

Results: Six patients out of 88 (6.8%) had complaints of reduction in jaw opening. These six patients seemed to have a much more abrupt onset of disease with shorter duration until diagnosis, higher prevalence of eye involvement (50% v 27%), and a higher rate of positive pathology (100%).

Conclusions: Reduction in jaw opening in the appropriate setting may indicate the presence of GCA. This sign should not be overlooked in the presence of the claudication sign as it seems to reflect more severe GCA disease.

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Giant cell arteritis (GCA) is a relatively common disease among elderly people in western communities. (1) The disease presents in most patients after the age of 60. Common complaints include non-specific signs such as fatigue, fever, headache, and muscle and girdle pains. These non-specific complaints in combination with the age of the patients and results from a few simple laboratory tests (such as increased erythrocyte sedimentation rate (ESR), serum alkaline phosphatase, and thrombocytosis) lead to the tentative diagnosis of GCA. The diagnosis is confirmed in most patients by a positive biopsy specimen from the temporal artery. In some patients other more unusual presentations can occur, leading to the delayed diagnosis of GCA and, at times, resulting in devastating complications, such as blindness. Sonnenblick et al have reviewed some of these rare presentations. (2)

Claudication of the jaw is considered a common manifestation of the …