Giant cell and Takayasu's arteritis.

Giant cell arteritis is a generalized vasculitis mainly affecting elderly people. The incidence is increasing, but only for women. The etiology is still unknown, but evidence suggests a cellular immunologic reaction against a local antigen present in the arterial wall. The disease can present itself with a great variety of symptoms. Constitutional symptoms such as fever, weight loss, and anorexia seem to be more common than hitherto believed. Onset of large artery involvement is independent of the evolution of the classic clinical symptoms. Peripheral synovitis is rarely seen in patients with polymyalgia rheumatica, and when it occurs, it is transient, nonerosive, and nondeforming. Glucocorticosteroids are the only generally accepted treatment in giant cell arteritis. After a higher initial dose of corticosteroids, most patients can be treated with a low maintenance dose, with little risk of steroid-induced osteoporosis. The erythrocyte sedimentation rate is still the best test for monitoring the disease.