Page 309 - The Vasculitides, Volume 1: General Considerations and Systemic Vasculitis

Systemic Vasculitis of the Gastrointestinal Tract 283

While clinically evident mesenteric involvement in uncommon, occult radiographic
manifestations were noted on arteriography in 18% of patients with GCA [4, 37, 38].

Of 11 patients with bowel involvement in GCA, nine were biopsy-proven [4, 7, 39-46],
of whom four presented with abdominal symptoms in the absence of symptoms of temporal
arteritis. Temporal artery biopsy was positive in only two of the four patients suggesting a
negative temporal artery biopsy was unable to reliably exclude GCA involving the mesenteric
vasculature [4].

Table 4. The American College of Rheumatology 1990 Criteria for the Classification
of Giant Cell Arteritis*

Criteria Definition

Age at disease Development of symptoms beginning at age 50 years or

onset > 50 years older

New headache New onset of or new type of localized pain in the head

Temporal artery abnormality Temporal artery tenderness on palpation or decreased

Elevated ESR pulsation, unrelated to arteriosclerosis of cervical arteries
ESR>50mm in the 1st hour by the Westergren method

Abnormal artery biopsy Biopsy specimen with artery showing vasculitis

characterized by a predominance of mononuclear cell

infiltration or granulomatous inflammation, usually with

multinucleated giant cells

For the purposes of classification at least 3 criteria must be fulfilled; sensitivity 93.5%, specificity
91.2%.

*Adapted from [34].

Table 5. The American College of Rheumatology 1990 Criteria for the Classification of
Polyarteritis Nodosa*

Otherwise unexplained weight loss of > 4 kg
Presence of livedo reticularis
Testicular pain or tenderness
Myalgia (excluding that of the shoulder hip and girdle) or weakness
Mononeuropathy or polyneuropathy
New onset rise in diastolic blood pressure > 90 mm Hg
Elevated levels of serum blood urea nitrogen (>40 mg/dL or >14.3 mmol/L) or creatinine
(>1.5 mg/dL or > 132 µmol/L)
Evidence of hepatitis B virus infection via serum antibody or antigen serology
Characteristic arteriographic abnormalities not resulting from non-inflammatory disease
processes
A biopsy of medium or small sized artery containing polymorphonuclear cells
For the purposes of classification at least 3 criteria must be fulfilled; sensitivity 82%, specificity 87%.
*Adapted from [48].

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