[Eye complications in 458 children with rheumatoid arthritis]. / Augenbeteiligung bei 458 Kindern mit Erkrankungen des rheumatischen Formenkreises.

BACKGROUND: Besides arthritis or other systemic manifestations, endogenous inflammation (most commonly uveitis) can be a symptom of rheumatoid arthritis in children. The uveitis of children shows certain differences compared to that in adults. This study will show these differences and their incidences. PATIENTS AND METHODS: Retrospective analysis of the histories of 458 children that were admitted to the pediatric clinic due to rheumatism related diseases. An analysis of the general and pediatric data, laboratory results and therapy were combined with the ophthalmologic data. RESULTS: 45 (9.8%) of the 458 patients suffered from uveitis at least once during the studied time period between 1992 and 1996. Most common complications of the therapy were clouding of the lens up to full cataract (in both eyes in eight out of nine patients). Seven patients underwent cataract operation. Further complications are synechiae, band shaped keratopathy, secondary glaucoma and retinal diseases. CONCLUSION: Since the pediatric uveitis usually does not take an acute course and since children rarely can articulate themselves precisely, a regular ophthalmologic examination of pediatric rheumatology patients is necessary, as well as every uveitis in children should warrant pediatric-rheumatologic diagnostics. The impact of uveitis is much more severe for children when compared to adults, since it not only endangers the vision but the whole development of the child.

Color duplex ultrasonography in large-vessel giant cell arteritis.

In a patient with active extracranial giant cell arteritis, duplex ultrasonography demonstrated hypoechoic mural thickening of the brachial, axillary, subclavian, and carotid arteries with bilateral subtotal occlusions of the brachial and axillary arteries. The ultrasound image of the artery walls became midechoic within 8 weeks, and hyperechoic within one year after start of treatment with corticosteroids. A similar hypoechoic mural thickening of the temporal arteries has been recently described in active giant cell arteritis. The dark ultrasound image is due to an edema of the vessel wall in the acute stage. The brighter ultrasound image might be due to fibrosis in the chronic stage of the disease.

Color duplex ultrasonography in the diagnosis of temporal arteritis.

BACKGROUND: The diagnosis of temporal arteritis usually requires a biopsy of the temporal artery. We examined the usefulness of color duplex ultrasonography in patients suspected of having temporal arteritis. METHODS: In this prospective study, all patients seen in the departments of rheumatology and ophthalmology from January 1994 to October 1996 who had clinically suspected active temporal arteritis or polymyalgia rheumatica were examined by duplex ultrasonography. The final diagnoses, made according to standard criteria, were temporal arteritis in 30 patients, 21 with biopsy-confirmed disease; polymyalgia rheumatica in 37; and negative histologic findings and a diagnosis other than temporal arteritis or polymyalgia rheumatica in 15. We also studied 30 control patients matched for age and sex to the patients with arteritis. Two ultrasound studies were performed and read before the biopsies; one ultrasonographer was unaware of the clinical information. RESULTS: In 22 (73 percent) of the 30 patients with temporal arteritis, ultrasonography showed a dark halo around the lumen of the temporal arteries. The halos disappeared after a mean of 16 days (range, 7 to 56) of treatment with corticosteroids. Twenty-four patients (80 percent) had stenoses or occlusions of temporal-artery segments, and 28 patients (93 percent) had stenoses, occlusions, or a halo. No halos were identified in the 82 patients without temporal arteritis; 6 (7 percent) had stenoses or occlusions. For each of the three types of abnormalities identified by ultrasonography, the interrater agreement was > or =95 percent. CONCLUSIONS: There are characteristic signs of temporal arteritis that can be visualized by color duplex ultrasonography. The most specific sign is a dark halo, which may be due to edema of the artery wall. In patients with typical clinical signs and a halo on ultrasonography, it may be possible to make a diagnosis of temporal arteritis and begin treatment without performing a temporal-artery biopsy.

[Color Doppler ultrasound of the temporal arteries--a new method for diagnosing temporal arteritis]. / Farbdopplersonographie der Temporalarterien--eine neue Methode zur Diagnostik der Arteriitis temporalis.

BACKGROUND: Recently increasing attention has been paid to temporal arteritis which is not a very rare disease. Early establishment of the diagnosis and start of therapy can reduce serious visual complications. PATIENTS AND METHODS: The temporal arteries of 10 patients with temporal arteritis, 8 patients with polymyalgia rheumatica, and 23 controls were investigated with a high resolution ultrasound system, measuring size of lumen and wall as well as blood flow velocity. RESULTS: Colour doppler sonography of the superficial temporal artery showed a characteristic hypoechoic halo around the perfused lumen of an often stenosed or occluded artery. Neither patients with polymyalgia rheumatica nor controls had this hypoechoic halo. The halo disappeared 10-14 days after start of therapy with glucocorticoids. CONCLUSIONS: We think that colour doppler sonography of the temporal arteries is a simple, quick, and non-invasive method to diagnose temporal arteritis. When there will be more experience, sensitivity and specificity of the method can be defined. Perhaps sonography might replace biopsy in some cases in the future.