Masticatory muscle pain: an important indicator of giant cell arteritis. 1998

S S Hayreh
Department of Ophthalmology, College of Medicine, University Hospitals & Clinics, Iowa City, Iowa 52242-1091, USA.

Giant cell arteritis (GCA) is a polysymptomatic disease which constitutes an ophthalmic emergency because early recognition and management can prevent blindness. There is conflicting information in the literature on the validity, sensitivity, and specificity of various systemic symptoms and signs of GCA. This paper presents a review of our prospective studies on the subject, and our findings are particularly relevant to dentists. We investigated 363 patients in a prospective study. Positive temporal artery biopsy was seen in 106 patients and negative in 257 referred for diagnosis of GCA. Systemic symptoms and signs of GCA and erythrocyte sedimentation rate (Westergren-ESR) and C-reactive protein (CRP) levels were compared in these two groups of patients. The odds of having a positive temporal artery biopsy (i.e., GCA) were 9.1 times greater with jaw claudication (pain in masticatory muscles on eating), 3.4 times with neck pain, 3.2 times with CRP > 2.45 mg/dL, 2.0 times with ESR 47.107 mm/hr, 2.7 times with ESR > 107 mm/hr, and 2.0 times when the patients were aged > or = 75 years. Other signs and symptoms did not show a significant association with a positive biopsy. Our study showed that "normal" ESR values do not rule out GCA but that CRP is a more useful test than ESR. Since jaw claudication is one of the most important symptoms of GCA, dentists should keep this possibility in mind when older patients come complaining of jaw pain while eating.

UI MeSH Term Description Entries
D008297 Male Males
D008410 Masticatory Muscles Muscles arising in the zygomatic arch that close the jaw. Their nerve supply is masseteric from the mandibular division of the trigeminal nerve. (From Stedman, 25th ed) Masticatory Muscle,Muscle, Masticatory,Muscles, Masticatory
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D008881 Migraine Disorders A class of disabling primary headache disorders, characterized by recurrent unilateral pulsatile headaches. The two major subtypes are common migraine (without aura) and classic migraine (with aura or neurological symptoms). (International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004: suppl 1) Acute Confusional Migraine,Headache, Migraine,Status Migrainosus,Abdominal Migraine,Cervical Migraine Syndrome,Hemicrania Migraine,Migraine,Migraine Headache,Migraine Variant,Sick Headache,Abdominal Migraines,Acute Confusional Migraines,Cervical Migraine Syndromes,Disorder, Migraine,Disorders, Migraine,Headache, Sick,Headaches, Migraine,Headaches, Sick,Hemicrania Migraines,Migraine Disorder,Migraine Headaches,Migraine Syndrome, Cervical,Migraine Syndromes, Cervical,Migraine Variants,Migraine, Abdominal,Migraine, Acute Confusional,Migraine, Hemicrania,Migraines,Migraines, Abdominal,Migraines, Acute Confusional,Migraines, Hemicrania,Sick Headaches,Variant, Migraine,Variants, Migraine
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D012044 Regression Analysis Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable. Regression Diagnostics,Statistical Regression,Analysis, Regression,Analyses, Regression,Diagnostics, Regression,Regression Analyses,Regression, Statistical,Regressions, Statistical,Statistical Regressions
D001799 Blood Sedimentation Measurement of rate of settling of ERYTHROCYTES in blood. Erythrocyte Sedimentation,Erythrocyte Sedimentation Rate,Erythrocyte Sedimentation Rates,Rate, Erythrocyte Sedimentation,Rates, Erythrocyte Sedimentation,Sedimentation Rate, Erythrocyte,Sedimentation Rates, Erythrocyte,Sedimentation, Blood,Sedimentation, Erythrocyte
D002097 C-Reactive Protein A plasma protein that circulates in increased amounts during inflammation and after tissue damage. C-Reactive Protein measured by more sensitive methods often for coronary heart disease risk assessment is referred to as High Sensitivity C-Reactive Protein (hs-CRP). High Sensitivity C-Reactive Protein,hs-CRP,hsCRP,C Reactive Protein,High Sensitivity C Reactive Protein
D003027 Cluster Headache A primary headache disorder that is characterized by severe, strictly unilateral PAIN which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15-180 min. occurring 1 to 8 times a day. The attacks are associated with one or more of the following, all of which are ipsilateral: conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial SWEATING, eyelid EDEMA, and miosis. (International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004: suppl 1) Ciliary Neuralgia,Headache, Cluster,Histamine Cephalgia,Horton Syndrome,Neuralgic Migraine,Atypical Cluster Headache,Chronic Cluster Headache,Cluster Headache Syndrome,Episodic Cluster Headache,Horton's Syndrome,Atypical Cluster Headaches,Cephalgia, Histamine,Cephalgias, Histamine,Chronic Cluster Headaches,Ciliary Neuralgias,Cluster Headache Syndromes,Cluster Headache, Atypical,Cluster Headache, Chronic,Cluster Headache, Episodic,Cluster Headaches,Cluster Headaches, Atypical,Cluster Headaches, Chronic,Cluster Headaches, Episodic,Episodic Cluster Headaches,Headache Syndrome, Cluster,Headache Syndromes, Cluster,Headache, Atypical Cluster,Headache, Chronic Cluster,Headache, Episodic Cluster,Headaches, Atypical Cluster,Headaches, Chronic Cluster,Headaches, Cluster,Headaches, Episodic Cluster,Histamine Cephalgias,Hortons Syndrome,Migraine, Neuralgic,Migraines, Neuralgic,Neuralgia, Ciliary,Neuralgias, Ciliary,Neuralgic Migraines,Syndrome, Cluster Headache,Syndrome, Horton,Syndrome, Horton's,Syndromes, Cluster Headache
D003937 Diagnosis, Differential Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis

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