மூலக்கூறு உயிரியல்: திறந்த அணுகல்

Giant Cell Arteritis Overlapping with Rheumatoid Arthritis and Sjogren's Syndrome

Abstract

Jing Wang, Lingyan Zhou and Jing Gao

Background: Giant cell arteritis (GCA) is an autoimmune vasculitis involving large and medium arteries, but the relationship with other autoimmune diseases is unclear. We reported a case of an 85-year-old woman who was diagnosed with GCA, Sjögren’s syndrome (SS) and rheumatoid arthritis (RA) simultaneously, and discussed the potential link between these diseases.

Case presentation: An 85-year-old Chinese woman was admitted to hospital with aggravation of pain in two knees with headache and blurred vision. She had a history of rheumatoid arthritis and rheumatoid heart disease for 30 years and atrial fibrillation for 1 year. On admission, she had bilateral temporal pain accompanied by blurred vision. Physical examination showed dry tongue and decreased coating on the tongue. Initial laboratory results showed that C-reactive protein (CRP) was 24.89 mg/L (normally 0-5), and erythrocyte sedimentation rate (ESR) was 42.4 mm/h (normally 0-20), both of them were significantly elevated.

Results: The anti-nuclear antibody (ANA) and anti-centromere antibody (ACA) was positive in serum. Color Doppler ultrasound of temporal arteries showed thickening and hardening of bilateral temporal artery wall with varying width and narrowness of lumen. She was diagnosed with GCA, SS, and RA. At the same time, she was given antiinflammatory treatment with methylprednisolone, hydroxychloroquine and tripterygium glycosides. Her condition was controlled; the mental state and inflammatory biomarkers were significantly improved (CRP < 0.5 mg/L, ESR 13.6 mm/h). She was discharged from the hospital and outpatient review regularly.

Conclusion: GCA, SS, and RA can occur simultaneously or continuously, but were rare. The combination of CRP and ESR improved the specificity and positive rate of GCA diagnosis. We speculated that there might be common pathogenic factors involved in GCA, RA and SS through the analysis of this case. Through the analysis of this case, we speculated that there may be a common virulence factor involved in GCA, RA and SS. Further exploration is needed in the future to elucidate their relationship and provide more support for early diagnosis and treatment.