Temporal Arteritis (Giant Cell Arteritis), Dawolo dimi ni a bɛ ɲimi, ani yeli barikama¶

Kungolodimi kura min bɛ senkɔni kelen walima a fila bɛɛ kan, kunsigi bɛ sɔgɔsɔgɔ ni aw bɛ aw kunsigi sɔgɔ, walima ni aw bɛ aw kunsigi sɔgɔsɔgɔ ni aw bɛ dumuni ɲimi baliku la min si bɛ san 50 la walima ka tɛmɛ o kan, o ye furakɛli kɔrɔtɔlen ye min bɛ wele ko Temporal Arteritis walima Giant Cell Arteritis (GCA). Ni nin joli-sira-funu-bana in min bɛ kɛ ni farikolo tangalan ye, o bɛ funu ani ka a kuru ka bɔ ɲɛdimi ni kɔfɛla sɔgɔsɔgɔninjɛ surunw bolow la minnu bɛ ɲɛkisɛ balo, o bɛ kɛ sababu ye ka ɲɛ kelen fiyentɔya barikama, dimi tɛ min na, min tɛ se ka segin kɔ (Arteritic Anterior Ischemic Optic Neuropathy [A-AION]). Kɔrɔtɔko min ka bon ni o ye, ni ɲɛ fɔlɔ ye yeli kɛ tuguni, banabagatɔ minnu ma furakɛ, olu kɛmɛsarada la, 30 fo 50 bɛ fiyen kudayi u ɲɛ filanan (min tolen) la sanga 24 fo tile 7 kɔnɔ. Ni aw walima mɔgɔ min si bɛ san 50 la walima ka tɛmɛ o kan, ni aw ye kungolodimi kura, dawolo kirinni ni aw bɛ a ɲimi, ka yeli kɛ siɲɛ fila, ka ɲɛnayeli kɛ waati kunkurunnin kɔnɔ, walima ka yeli kɛ yɔrɔnin kelen, aw bɛ aw ka sigida kɔrɔtɔko nimɔrɔ wele o yɔrɔnin bɛɛ fɛ kɔrɔtɔko nimɔrɔw. Segin joli-sira-funu ni ɲɛda-la-ko kɔrɔtɔlenw kan minnu bɛ tali kɛ o la san ɲɛnamini ni ɲɛda cɛmancɛ joli siraw datugucogo, . ɲɛnayeli barikama, ɲɛkisɛw bɔli, ani ɲɛnamini min bɛ kɛ kɛrɛfɛ, ani sɔgɔsɔgɔninjɛ dɔnni ani kɔrɔtɔko jaabi.

Aw bɛ o kɛ sisan¶

1. Aw bɛ aw ka sigida ka kɔrɔtɔko nimɔrɔ wele walima ka taa dɔgɔtɔrɔso la joona joona (911 Ameriki ani Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri jamana kɔnɔ) ni baliku min si bɛ san 50 la walima ka tɛmɛ o kan, o ye Yɛlɛma fɛn o fɛn yeli yeli la (ɲɛnabɔli, rido dibiman, sisi min bɛ kɛ ni kretiɛn ye, miniti 5 kɔnɔna na, a yeli kunkurunnin, walima yeli fila) OR a kura kungolodimi min bɛ fara ɲɔgɔn kan ni dawolodimi ye ni a bɛ ɲimi walima kungolodimi. Aw kana ɲɛda dɔgɔtɔrɔ, ɲinw furakɛla walima furakɛli fɔlɔ lajɛ makɔnɔ abada dɔgɔkun nata la.
2. Aw bɛ ɲɛ kelen kelen bɛɛ sɛgɛsɛgɛ a danma sisan yɛrɛ ni aw bɛ ɲɛ kelen datugu a waati kelen na ni aw bolokɔni ye. A ka ca a la banabagatɔw t’a dɔn ko ɲɛ kelen ye a tilancɛ walima a bɛɛ bɔ fo ka se u ɲɛ ɲuman datugu. Lɛrɛ ni miniti tigitigi min ye yeli dibi, biɲɛ walima yeli fila daminɛna, i k’o sɛbɛn.
3. Aw ye sɛgɛsɛgɛli kɛ joona walasa ka "Drape rouge duuru kunkolo ni sistɛmu de la arteritis cellulaire géantes" sɔrɔ:
4. Dɔgɔtɔrɔ walima kan sɔgɔli: Yala i dawolo, i ɲɛda walima i kan bɛ dimi daminɛ, ka kirin, walima ka sɛgɛn dumuni nɔgɔlenw (i n’a fɔ sogo walima buru) ɲimi kɔfɛ sekɔndi 60 fo 90 kɔnɔ, o bɛ i wajibiya ka jɔ ka lafiɲɛ wa?
5. Kunkolo sɔgɔsɔgɔ: Ni aw bɛ aw kunsigi bruise, ka ɲɛkisɛw don walima ka fini don, walima ka aw kunkolo lafiɲɛ barajuru kan, o bɛ dimi walima ka sɔgɔsɔgɔ aw ɲɛda walima aw kunsigi kan wa?
6. Abnormal superficial temporal artery: Yala joli sira min bɛ i tulo ɲɛfɛ dɔrɔn ani i senkɔni kɛrɛfɛ, o bɛ i ko a bɛ ye walima a bɛ kurukuru, a bɛ kɛ i n’a fɔ a bɛ nɔgɔya walima a bɛ i n’a fɔ juru ni i magara a la ni dususuma ye, walima a tɛ kɛ ni dusukun tantanni ye wa?
7. Lasɔmini taamasiɲɛ minnu bɛ ye waati tɛmɛnenw na: Yala aw ye ɲɛ kelen kɛ ni ɲɛ jɛman walima dibi ye miniti 2 fo miniti 15 kɔnɔ (amaurosis fugax) walima yeli fila (diplopie) waati kunkurunnin kɔnɔ tile damadɔ tɛmɛnenw kɔnɔ wa?
8. Polymyalgia Rheumatica (PMR) ani farikolo funu: Yala sɔgɔmadafɛla gɛlɛya jugumanba ni dimi kɛra aw kamankun, kɔ ani kɔ fila bɛɛ la min bɛ mɛn ka tɛmɛ miniti 45 kan, sumaya hakɛ dɔgɔman ɲɛfɔbali, sufɛ sumaya, walima aw farikolo girinya dɔgɔyara k’a sɔrɔ aw ma laɲini wa?
9. A fɔ kɛnɛyaso kɔrɔtɔlen infirɛri ni dɔgɔtɔrɔ ye joona i selen kɔ: "An bɛ siga la ko Giant Cell Arteritis (Temporal Arteritis) bɛ a la, wa an mago bɛ jateminɛ teliya la stat high-dose corticosteroids la walasa ka yeli tanga." Ni aw bɛ baara kɛ ni dɔgɔtɔrɔso tɔgɔ tigitigi ye, o bɛ aw kunkolodimi bali ka triage kɛ i n'a fɔ kungolodimi walima kunkolodimi min tɛ fɔlɔ ye, wa a bɛ aw ka jaw dimi bali ka kɛ a sɛgɛsɛgɛra cogo jugu la ko a ye ɲinw walima TMJ gɛlɛya ye.
10. Aw ka aw jija ko kɔritikositɛri furakɛli TƐ kɔtigɛ ka a sɔrɔ aw bɛ joli siraw lajɛ waatilama walima ultrasound lajɛ makɔnɔ. Ameriki ka sɔgɔsɔgɔninjɛ furakɛli kalanso (ACR), Erɔpu (EULAR), ani Angletɛri (BSR) ka laadilikanw kɔnɔ, kɔritikositɛri hakɛ caman ka kan ka di jolisira fɛ walima da la o yɔrɔnin bɛɛ ni aw ye siga kɛ kɛnɛyaso la biyɔpisi bɛ to ka sɛgɛsɛgɛli kɛ tile 10 fo tile 14 sitɛrɛpiti tali daminɛ kɔfɛ, ka sɔrɔ ka biyopisi makɔnɔ lɛri 24 kɔnɔ ni sitɛroyi tɛ a la, o bɛ se ka ɲɛ tɔ fiyen fo abada.
11. Aw kana tansiyɔn furakisɛ wɛrɛw ta walima joli siraw bonya sani aw ka se dɔgɔtɔrɔso la. Ni aw ye tansiyɔn jigin, o bɛ dɔ bɔ pikirijikɛlan tansiyɔn na ka tɛmɛ kɔfɛla sɔgɔsɔgɔninjɛ surunw kan minnu dɔgɔyara kaban, minnu bɛ ɲɛkisɛ kunkolo balo, wa a bɛ se ka ɲɛkisɛw ka sɔgɔsɔgɔninjɛ dafalen teliya.

Desizɔn jiri : Triage ni steroid kɔrɔtɔlen don ni siga bɛ a la ko Giant Cell Arteritis¶

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    Start["Baliku si >= San 50 Ni kungolodimi kura, kunsigi dimi, dawolo dimi, PMR, walima ɲɛnayeli yeli"] --> VisionCheck{"Yala taamasiɲɛ minnu bɛ ye, olu bɛ yen wa? (Dɔgɔtɔgɔnin banbali, ombre altitude, sisi kretiɛn, dimming 5-min surun / amaurosis fugax, OR yeli fila)"}

    VisionCheck -->|"ƆWƆ: Ɲɛnayeli bɔnɛ, Dimi waati dɔɔnin, walima Diplopie Present"| VisualEmergency["ƝƐSIN ƝƐNABƆLI KƆRƆBƆLI (AW KA ƝƐ FILANAN KISI): 1. Aw bɛ telefɔni 911 / 112 / 999 wele -> Dɔgɔtɔrɔso Kɔrɔtɔko ɲɛmɔgɔso SISAN. 2. Aw bɛ Methylprednisolone (Methylprednisolone miligaramu 500 fo ka se miligaramu 1000 ma IV/tile x tile 3) di o yɔrɔnin bɛɛ sani aw ka biyopisi kɛ. 3. Aw bɛ Stat ESR, CRP, & CBC (Platelets) ja IV bilali la."]

    VisionCheck -->|"NO yecogo taamasiɲɛw Fɔlɔ"| JawIschemiaCheck{"Yala Jaw Claudication, Tongue Claudication, walima Limb/Cranial Ischemia bɛ yen wa?"}

    JawIschemiaCheck -->|"ƆWƆ: Dawolo/kan dimi ni a bɛ ɲimi (Fiyentɔya min bɛ se ka kɛ joona) ."| HighRiskCranial["HIGH-RISK CRANIAL GCA: 1. Kɔrɔtɔko ɲɛmɔgɔso ka jateminɛ BI. 2. Aw bɛ Pɛridinizɔni da la hakɛ caman tali daminɛ (miligaramu 60 tile kɔnɔ, walima miligaramu 1 kilogaramu o kilogaramu tile kɔnɔ) walima Metilpɛridinizɔni IV la joona. 3. Kɔrɔtɔko Fast-Track Temporal Artery Ultrasound + Biopsy tile 7 kɔnɔ."]

    JawIschemiaCheck -->|"NO Jaw Claudication (AN ye Jaw Claudication) ye"| ClassicCranialCheck{"Kungolodimi kura min bɛ kɛ yɔrɔ la, kungolodimi, kungolodimi, ɲɛgɛnɛsiralabanaw ka bonya/min tɛ wuli, walima PMR kamankun/kɔkolo gɛlɛya + ESR/CRP kɔrɔtalen?"}

    ClassicCranialCheck -->|"ƆWƆ: GCA min bɛ baara kɛ ni kunkolo walima joli siraba ye min tɛ gɛlɛya"| StandardGCA["GCA ACTIVE CRANIAL SANS ISCHEMIE : 1. Aw bɛ Pɛridinizɔni da la hakɛ caman daminɛ (miligaramu 40 fo ka se miligaramu 60 ma tile kɔnɔ) o yɔrɔnin bɛɛ bi (aw kana biyɔpisi makɔnɔ abada). 2. Aw ye waati bolodacogo kɛ ka ultrasound ("Halo Sign") ani/walima Temporal Artery Biopsy tile 7 fo ka se tile 14 ma. 3. Aw bɛ Tosilizumabi furakɛli jateminɛ min tɛ furakisɛw ta."]

    VisualEmergency --> BiopsyFollow["Sɛgɛsɛgɛli dafalen Stɛroyidi daminɛni kɔfɛ: Aw bɛ Doppler Kulɛri Temporal/Axillary Color Doppler Ultrasound + Temporal Artery Biopsy (a ka dɔgɔn santimɛtɛrɛ 1,5 fo 2,0 fixation kɔfɛ) kɛ tile 10 fo 14 kɔnɔ."]

Banakisɛfagalanw : Cogo min na autoimmune granulomatous vasculitis bɛ ɲɛ fiyen¶

Mun na joli-sira-funu-bana bɛ joli-sira-funu cɛmancɛ ni joli-sira-funu belebelebaw laɲini san 50 kɔfɛ¶

Giant Cell Arteritis (GCA), tariku la, a bɛ fɔ a ma ko Temporal Arteritis walima Horton Disease, o ye farikolojidɛsɛ fɔlɔ ye min ka teli ka kɛ balikuw la Tlebi jamanaw na, a bɛ sɔrɔ a bɛ se ka kɛ mɔgɔ kelen-kelen bɛɛ la minnu si bɛ san 50 la ka tɛmɛ o kan (a hakɛ cayalenba bɛ san 70 ni san 80 cɛ, wa a bɛ musow minɛ ka tɛmɛ siɲɛ 2 fo siɲɛ 3 kan cɛw).

A tɛ i n’a fɔ joli-sira-funu misɛnniw, farikolo tangalanw ka binkanni min bɛ GCA kɔnɔ, o bɛ jolisira cɛmancɛ ni belebelebaw laɲini minnu kɔnɔna na, lamina elastic bɛ minnu na, kɛrɛnkɛrɛnnenya la kɛnɛma ni kɔnɔna joli siraw kolo kɔkanna bolow, kolokolo jolisiraw, sɔgɔsɔgɔninjɛ ni kɔkanna joli, ani ** barajuru sɔgɔsɔgɔninjɛ: 1. Dendritic Cell Activation in the Adventitia: Yɛlɛma minnu bɛ kɛ joli siraw kogo la minnu bɛ sɔrɔ si hakɛ fɛ ani sigida laminiko fɛn dɔnbaliw bɛ joli siraw dendɛrɛsi selilɛriw baara minnu sigilen bɛ joli sira kɔkanna la (adventitia) Toll-like receptors fɛ. 2. CD4+ T-Cell Recruitment (Th1 ani Th17 siraw): Dendritic cellules activées bɛ CD4+ dɛmɛbaga T-lymphocytes ta vasa vasorum fɛ (balo joli sira misɛnnin minnu bɛ joli sira kogo balo). O T-cellw bɛ danfara ka kɛ funu bolokɔni fila ye minnu tɛ kelen ye: - Th17 / Interleukin-6 (IL-6) Bolo: A bɛ sugunɛ kɛ farikolojɔli dumuniw bɔli la farikolo la, minnu bɛ kɛ ni farikolojɔli dumuniw ye minnu bɛ fasa jugumanba la (protéine C-reactive, fibrinogène, serum amyloïde A), sumaya gɛlɛn, sufɛ sumaya, joli segin furakisɛ hakɛ caman sɔrɔli, ani Polymyalgia Rheumatica nin bolo in bɛ se ka kɛ ka ɲɛ kosɛbɛ kɔritikositɛriw ni IL-6 minɛbagaw balili (tosilizumab) la. - Th1 / Interferon-gamma (IFN-\(\gamma\)) Bolo: A bɛ makɔrɔfagaw ka fusili bila banakisɛba caman na minnu bɛ kɔnɔna lamini elasitiki sɔgɔ ka bɔ ɲɔgɔn na ani ka joli-sira-funu-kɔnɔ-fɛnw (PDGF) ni joli-sira-funu-kɔnɔ-fɛnw (VEGF) bɔ. 3. Concentric Intimal Hyperplasia (Luminal Occlusion): PDGF ni VEGF jaabi la, mikorofibroblaste bɛ taa kɔnɔna na ka caya joona joli sira kɔnɔna na (intima). Joli sira kogo bɛ funu ka taa kɔnɔna na fo ka se cɛmancɛ joli sira ma ka dɔgɔya ka kɛ pinɛ dingɛ ye walima ka datugu pewu ni joli-sira-funu ye (luminal occlusion), o bɛ kɔngɔ bila oksizɛni duguma yɔrɔw la.

Ɲɛkisɛ kɛrɛnkɛrɛnnen jumɛnw bɛ datugu GCA kɔnɔ?¶

Ni GCA bɛ bin orbit ka joli-sira-funu-yɔrɔ kan, a bɛ farikolo-ɲɛnajɛ-ɲini kabakoma jira Short Posterior Ciliary Arteries (SPCAs) la, o kɔfɛ Central Retinal Artery (CRA) ani Ophthalmic Artery: - GCA yeli bɔnɛ kɛmɛsarada la 80 fo 85 : Arteritic Anterior Ischemic Optic Neuropathy (A-AION). Kɔfɛla sɔgɔsɔgɔninjɛ surunw bɛ kɛ Zin-Haller sɛrɛkili ye min bɛ Prelaminar ni Laminar Optic Nerve Head ani Choroid di. Ni GCA ye kɔfɛla sɔgɔsɔgɔninjɛ surunw datugu, ɲɛkisɛ kunkolo bɛ kirinba dɔ sɔrɔ, min dafalen don. Fondoskopi sɛgɛsɛgɛli la, ɲɛkisɛ disiki bɛ i n’a fɔ ** a fununen don ani a bɛ i n’a fɔ "chalky white" (pallid disc edema)** sanni a ka kɛ pinki dɔrɔn ye, barisa joli zeru bɛ ​​to kapilɛri dilan na. - GCA yeli bɔnɛ kɛmɛsarada la 10 fo 15 : Arteritic Central Retinal Artery Occlusion (A-CRAO). A ka ca a la, a bɛ kɛ waati kelen na ni kɔfɛla sɔgɔsɔgɔninjɛ ye, o bɛ kɛ sababu ye ka ɲɛda ɲɛkisɛ finman dɔ bɔ min bɛ i n’a fɔ nɔnɔ bilenman ni nɔnɔ bilenman ye ka fara koroyidi non-perfusion kan. - GCA yeli bɔnɛ kɛmɛsarada la 5 : Arteritic Posterior Ischemic Optic Neuropathy (A-PION) walima Cilioretinal Artery Occlusion. A-PION la, ɲɛnamini bɛ kɛ ɲɛkisɛ kɔfɛ ɲɛkisɛ kɔfɛla la, o la ɲɛkisɛ bɛ kɛ cogo la tile fɔlɔ la hali ni fiyentɔya don pewu ani Relative Afferent Pupillary Defect (RAPD / Marcus Gunn kalanden), a bɛ kɛ jɛman ye ani ka kɛ atrophique ye dɔgɔkun 4 fo dɔgɔkun 6 o kɔfɛ.

Mun na yeli fila waati tɛmɛnen (diplopie) ani amaurosis fugax ye lasɔminiw ye sanga 24 kɔnɔ¶

Banabagatɔ kɛmɛsarada la 30 fo 40 minnu bɛ kɛ fiyentɔya ye kudayi ka bɔ Giant Cell Arteritis fɛ, olu ye lasɔmini taamasiɲɛw sɔrɔ tile 1 fo tile 7 SANI u ka fiyentɔya banbali minnu ma sɔrɔ walima minnu bɔra baara la: 1. Ɲɛkisɛ kelen bɔnɛni waati tɛmɛnen (Amaurosis Fugax in GCA): A tɛ i n’a fɔ amaurosis fugax embolique min bɛ bɔ karotidi plaque la (yɔrɔ min na kolosinsinnan kristalɛ bɛ joli sira datugu miniti 5 kɔnɔ), GCA kɔnɔ, a bɛ kɛ ni dimi ye min bɛ kɛ waati kunkurunnin kɔnɔ walima min bɛ kɛ ni jɛman ye, o bɛ kɛ barisa tansiyɔn bɛ kɛ ka tɛmɛ kɔfɛla sɔgɔsɔgɔninjɛ surunw kan minnu dɔgɔyara kosɛbɛ dakun min bɛ wele ko threshold. Ni aw wulila dɔrɔn ka bɔ sigilan kan, ka aw biri, walima ka tansiyɔn jigincogo ɲuman sɔrɔ su fɛ, o bɛ ɲɛkisɛw jiginni jigin a dancɛ jukɔrɔ miniti 5 fo miniti 20 kɔnɔ. 2. Diplopie transient walima persistente (Duble Vision, o bɛ sɔrɔ GCA kɛmɛsarada la 10 fo 15 la): ɲɛkisɛ kɔkanna farikolow minnu bɛ ɲɛkisɛw lamaga (ani kunsɛmɛnasumaya III, IV ani VI minnu b’u kɔlɔsi) olu bɛ balo ɲɛkisɛ farikolo yɔrɔw fɛ. Ni GCA ye o farikolojidɛsɛ ninnu dɔgɔya, ɲɛkisɛ kelen walima caman bɛ kɛ joli-sira-funu ye, o bɛ kɛ sababu ye ka yeli fila yeli kɛ yɔrɔnin kelen walima ka jɔ, o min ka teli ka wuli tile fɛ. Banabagatɔ o banabagatɔ si bɛ san 50 la walima ka tɛmɛ o kan, yeli fila kura ye Giant Cell Arteritis ye fo ka se a jira ko a tɛ ten wa a ka teli ka kɔn ɲɛkisɛw bɛɛ fiyentɔya ɲɛ sanga 24 fo lɛri 72 dɔrɔn.

Ka Temporal Arteritis ka kɛnɛyaso jiracogo dogolenw dɔn¶

Ikomi Giant Cell Arteritis bɛ kɛnɛma karotidi, kɔnɔna carotid, vertebral ani aortic arches bolo caman funu, banabagatɔw bɛ to ka taa fɔlɔ denso dɔgɔtɔrɔw fɛ, tulo ni dawolo dɔgɔtɔrɔsow fɛ, hakililabaarakɛlaw fɛ sanni ka taa ɲɛ dɔgɔtɔrɔw fɛ. Nin klasiki ladege ninnu dɔnni bɛ yeli ni ɲɛnamaya kisi:

1. The Dental & TMJ Mimic: Jaw sɔgɔli, kan sɔgɔli, ani ɲinw dimi¶

Jaw claudication bɛ sɔrɔ GCA** banabagatɔ kɛmɛsarada la **45 fo 50 ɲɔgɔn na, wa a bɛ a ka ca a la kosɛbɛ (sɛgɛsɛgɛli kɛrɛnkɛrɛnnen hakɛ min ka bon) ka tɛmɛ kɛnɛyaso taamasiɲɛ bɛɛ kan walasa ka temporal artery biopsy ɲuman kofɔ: - Anatomiki sababu: ɲɛnamaya joli, ɲɛda joli, ani kɔnɔna jolisira jugumanw (kɛnɛma karotidi bolow) minnu bɛ joli di masseter, temporal, ani pterygoid muscles of mastication ma, olu dɔgɔyali funu fɛ. - GCA Jaw Claudication ni TMJ Disorder walima Dental Abscess danfara cogo:

2. Farikolola lasɔmini: Kungolodimi ni kunsigi nekɔrɔsi¶

• Kunkolo sɔgɔsɔgɔninjɛ: Ikomi superficial temporal, posterior auricular, ani occipital arteries bɛ kunsigi galeal ni cutaneous layers di kunsigi la, kunsigi fari ischemie bɛ kɛ sababu ye ka kɔmi boli dɔrɔn kunsigi kɔnɔ, ka kunkolo lafiɲɛ barajuru kan, walima ka kalankɛ lunɛti don, i bɛ dimi kɛ i la.
• Kunkolo sɔgɔsɔgɔninjɛ: GCA jugumanba la min ma furakɛ, ni ɲɛda ni kɔkolo sanfɛla fila bɛɛ datugulen don pewu, o bɛ kɛ sababu ye fari yɔrɔ dɔw bɛ kɛ kungolodimi walima a kunberew la ka kɛ bulama ye, ka kurukuruw bɔ, ka kɛ kurukuruw ye ka kɛ sɔgɔsɔgɔninjɛ nɛrɛma ye (kungolo sɔgɔsɔgɔninjɛ), a ka ca a la a bɛ fili a daminɛ na ko a ye sɔgɔsɔgɔninjɛ (herpes zoster) walima fari kansɛri ye. Ikomi kungolodimi bɛ pan-cranial ischemia jugumanba jira, kungolodimi bɛ banabagatɔ minnu na, olu ka fiyentɔya bɛ fiyentɔya min bɛ kɛ ɲɔgɔn fɛ, o hakɛ ka ca ni kɛmɛsarada la 60 ye.

3. "Occult" Geant Cell Arteritis (Fiyentɔya banabagatɔ 20% tɛ kungolodimi zeru) .¶

Jaanba min bɛ furakɛli kɔrɔtɔlenw na, o ye k’a miiri ko banabagatɔ min kunkolodimi tɛ a la, o tɛ se ka kɛ ni Temporal Arteritis ye. Dɔgɔtɔrɔsow lajɛlenw y’a jira ko banabagatɔ kɛmɛsarada la 20 ɲɔgɔn minnu ka fiyentɔya barikama bɛ sɔrɔ biyɔpisi fɛ, ni u bɛ fiyentɔya barikama sɔrɔ, olu bɛ ni "Occult GCA" ye: u bɛ na ni ɲɛ kelen na ni dimi tɛ u la yɔrɔnin kelen ani kungolodimi zeru, kungolodimi zeru, ani waatila jolisira dɔ min bɛ dusukunnata ɲuman sɔrɔ, ni farikolojidɛsɛbanakisɛ misɛnniw dɔrɔn de bɛ u la (i n’a fɔ sɔgɔmada joona kamankun gɛlɛyali, sɛgɛn, girinya dɔgɔyali, walima ESR/CRP jiginni joli sɛgɛsɛgɛliw la). O la, banabagatɔ kelen-kelen bɛɛ min si bɛ san 50 la walima ka tɛmɛ o kan, n’a bɛ na ni acute Anterior Ischemic Optic Neuropathy (AION) walima Central Retinal Artery Occlusion (CRAO) ye, o ka kan ka stat ESR, CRP, ani Complete Blood Count (platelet) laboratuwariw sɔrɔ minnu jalen don Kɔrɔtɔko ɲɛmɔgɔso la.

4. Polymyalgia Rheumatica (PMR) ka ɲɔgɔn sɔrɔ (GCA banabagatɔw 50%) .¶

Polymyalgia Rheumatica (PMR) ni Giant Cell Arteritis ye banaw ye minnu bɛ tali kɛ ɲɔgɔn na kosɛbɛ farikolo tangacogo kelen na: - Banabagatɔ kɛmɛsarada la 40 fo 50 minnu sɔrɔla ni Giant Cell Arteritis ye, PMR taamasiɲɛw bɛ u la ɲɔgɔn fɛ. - Banabagatɔ kɛmɛsarada la 15 fo 20 minnu sɔrɔla a daminɛ na ni PMR kelen ye (minnu bɛ piridinizɔni tata hakɛ dɔgɔman ta, \(10\text{ ka se }15\text{ mg/day}\), ni dimi, kamankunw, kɔ ani kɔkiliw bɛ gɛlɛya sɔgɔma) olu bɛ sɔrɔ kɔfɛ, u bɛ kɛ ni Giant Cell Arteritis dafalen ye. - Ladilikan jugumanba PMR banabagatɔw ma: Piridinizɔni tata hakɛ dɔgɔman (\(10\text{ ka se }20\text{ mg}\) don o don) bɛ kamankun gɛlɛya furakɛ PMR la nka a barika tɛ se ka fiyentɔya bali ka bɔ Giant Cell Arteritis la. PMR bɛ banabagatɔ o banabagatɔ la, ni kungolodimi kura bɛ a la, ni a kunsigi bɛ sɔgɔsɔgɔ, ni a bɛ a dawolo dimi ni a bɛ ɲimi, walima ni a ɲɛ bɛ wuli, o ka kan ka taa joona kɛnɛyaso la walasa ka taa ɲɛ ka taa a bila GCA steroid furakɛli hakɛ caman na (\(60\text{ mg}\) da la walima \(1,000\text{ mg}\) IV).

5. GCA min bɛ kɛ ni joli siraba ye, Subclavian Steal, ani Brainstem Stroke¶

GCA banabagatɔ kɛmɛsarada la 30 fo 80 la minnu ja kɛra ni PET-CT walima CT angiography ye, jolilabanaw (granulomatous vasculitis) bɛ taa ka tɛmɛ ɲɛdawolo kan ka taa aorta, subclavian, axillary ani vertebral arteries kɔnɔ: - Boloci ni joli tansiyɔn tɛ kelen ye: Ni bolokɔniw ni kɔkiliw bɛ dɔgɔya, o bɛ kɛ sababu ye ka bolokɔniw sɛgɛn dimi ni aw bɛ fɛnw kɔrɔta san fɛ, ni aw bɛ bolow nɛnɛ, ni aw bɛ wuli ka bɔ u kun na, ani ni tansiyɔn sistoliki danfara bɛ \(>10\text{ ka se }15\text{ mmHg}\) ma bolokɔni numanbolo ni numanbolo cɛ. - Vertebrobasilar Brainstem and Cerebellar Strokes: A tɛ i n’a fɔ joli siraw sɔgɔsɔgɔninjɛ (min bɛ kunkolo kɔnɔ joli siraw minɛ), GCA bɛ kunkolo kɔkanna jolisiraw laɲini kosɛbɛ ni u bɛ wuli ka tɛmɛ kɔ fɛ sani a ka dura mater sɔgɔ. GCA banabagatɔ kɛmɛsarada la, fo ka se 4 fo 7 ma, o bɛ kɛ ni kirinni jugumanba ye, a ka teli ka kɛ kɔkolo yɔrɔ la (o bɛ kɛ sababu ye ka kirinni barikama bila mɔgɔ la, ka balansi/ataxia, kuma gɛlɛya, dumunikɛbaliya, walima ɲɛda fila fiyentɔya). - Barbara basigilen ni a tigɛcogo: GCA banabagatɔw ka barajuru sɔgɔsɔgɔninjɛ hakɛ ka ca ni siɲɛ 17 ye ani... aorte (aorte) tigɛcogo** ni a bɛ tali kɛ ɲɔgɔn na ni u si hakɛ bɛ bɛn ɲɔgɔn ma, o bɛ a ɲini ka aorte ja lajɛ daminɛ na ani waati ni waati.

Joli sɛgɛsɛgɛli kɔrɔtɔlenw ani sɛgɛsɛgɛli ja minnu bɛ kɛ dɔgɔtɔrɔso la¶

1. Joli sɛgɛsɛgɛli saba wajibiyalenw : ESR, CRP ani joli segin furakisɛw¶

Sani aw ka metilprednisolone tali jolisira la, dɔgɔtɔrɔ minnu bɛ kɛnɛyaso la, olu bɛ joli sɛgɛsɛgɛli teliya saba kɛ: 1. C-Reactive Protein (CRP): Fasa-fasa taamasiɲɛ min ka gɛlɛn kosɛbɛ (a bɛ \(>5\text{ kɔrɔta ka se }10\text{ mg/L}\) ma GCA furakɛbali kɛmɛsarada la 95 fo 98 la). CRP tɛ i n’a fɔ ESR, a tɛ tiɲɛ jolidɛsɛ walima joli kuru bilenmanw cogoya fɛ, wa a bɛ wuli ka jigin joona ni funu baara ye. 2. Erythrocyte Sedimentation Rate (ESR / Westergren Sedimentation Rate): A jogo bɛ kɔrɔta kosɛbɛ (a ka c’a la \(>50\text{ ka se }100+\text{ mm/hour}\) ma GCA kɔnɔ. - ESR sanfɛla dancɛ ladilancogo nɔrɔlen jatebɔcogo: Cɛw fɛ, \(\text{Max Normal ESR} = \text{Age} \div 2\). Musow ta fan fɛ, \(\text{Max Normal ESR} = (\text{San} + 10) \div 2\). (Misali la, muso san 70 la, ESR min bɛ se \(40\text{ mm/hr}\) ma, o bɛ se ka kɛ normal ye; GCA la, a ka c’a la, a bɛ \(60\text{ ka se }120\text{ mm/hr}\) ma). 3. Joli jate dafalen (CBC) Ni aw ye joli segin furakisɛw lajɛ kɛrɛnkɛrɛnnenya la (Trombocytosis réactif): Ni Interleukin-6 hakɛ caman bɛ a bila senkan, thrombocytose réactive (joli hakɛ \(>400,000/\mu\text{L}\)) bɛ sɔrɔ GCA banabagatɔ kɛmɛsarada la 50 ni kɔ la minnu bɛ baara la, wa tiɲɛ na, a ye waati kuntaalajan joli sira ɲuman jiralan kɛrɛnkɛrɛnnen ye biyɔpisi ka tɛmɛ ESR dɔrɔn kan, ka fara normocytic jolidɛsɛ kan funu basigilen.

2. Ultrason vasculaire rapide ("The Halo Sign") ni Temporal Artery Biopsy ye¶

Ni kɔritikositɛri hakɛ caman daminɛna Kɔrɔtɔko ɲɛmɔgɔso la walasa ka banabagatɔ ka ɲɛ tanga, sɔgɔsɔgɔninjɛ, ɲɛdimi ani joli siraw opereli jɛkuluw bɛ bana in sɛgɛsɛgɛ ni fɛɛrɛ fila ye minnu bɛ ɲɔgɔn dafa:

• Ultrasound Doppler kulɛrilen min bɛ kɛ ni joli siraw ni joli siraw ye (First-Line in EULAR Guidelines):
• Sonda ultrasound min bɛ kɛ ni joli siraw ye, o bɛ kɛ sababu ye ka ɲɛgɛnɛsira fila sanfɛla lajɛ (boloci, ɲɛda ni kɔfɛla bolo minnu bɛ sɔrɔ ɲɔgɔn fɛ) ani kɔfɛla joli sira fila.
• "Halo Taamaʃyɛn": Funubana min bɛ joli sira kogo kɔnɔ, o bɛ ye i n'a fɔ dibi, bololanɛgɛ min tɛ se ka digidigi ("halo") min bɛ Doppler joli bolicogo kulɛri kulɛri lamini.
• Timing Window for Ultrasound: A tɛ i n’a fɔ biyopisi caman cili (min bɛ kɛ dɔgɔkun 2 kɔnɔ), ultrasound Halo Sign bɛ daminɛ ka dɔgɔya joona ni IV stɛroyi hakɛ caman daminɛna ani a bɛ se ka tunun steroid furakɛli tile 3 fo tile 7 kɔfɛ. O la, joli siraw sɛgɛsɛgɛli teliya ka kan ka kɛ a ka fisa lɛrɛ 24 fo lɛri 72 kɔnɔ, furakisɛ tali daminɛ kɔfɛ.
• Biopsie temporelle d’artérie (TAB, Histopathologie standard sanu):
• A bɛ kɛ i n’a fɔ kɛnɛyaso kɔkan opereli misɛnninw sigida lidokayini anestezi kɔnɔ, ka ɲɛdawolo sanfɛla yɔrɔ dɔ tigɛ taamasiɲɛ fan fɛ.
• Mun na Biopsy Specimen Length (\(\ge 1.5\text{ to }2.0\text{ cm}\)) nafa ka bon ("Skip Lesions"): Giant Cell Arteritis bɛ joli sira funu yɔrɔ dɔw la ("skip lesions"), o kɔrɔ ye ko joli sira milimɛtɛrɛ 5 bɛ se ka kɛ i n’a fɔ a bɛ cogo la pewu ka se milimɛtɛrɛ 5 ma min bɛ funu jugumanba la. Walasa ka biyopisi nkalonma-negatif bali ka yɔrɔ sanuman dɔ ta, operelikɛlaw bɛ joli sira yɔrɔ min ma jɔ, o bɛ kɛ santimɛtɛrɛ 2,0 fo 2,5 la a dɔgɔyalenba la (a bɛ se ka kɛ santimɛtɛrɛ 1,5 fo 2,0 ye a dɔgɔyalenba la foromalini sirilen kɔfɛ) ani ka tigɛli caman sɛgɛsɛgɛ minnu bɛ tugu ɲɔgɔn na.
• Timing Window for Biopsy: Granulomatous infiltrates, geant cells, ani fragmentation of the internal elastic lamina to yelen ka jɛya mikroskɔpu kɔnɔ fo a dɔgɔyalenba la tile 10 fo tile 14 (ani a ka ca a la fo dɔgɔkun 4) kɔritikositɛri hakɛ caman daminɛ kɔfɛ. Aw kana siteroyidi daminɛni bila kɔfɛ abada walasa ka biyɔpisi yɔrɔ makɔnɔ.

Dɔgɔtɔrɔso kɔritikositɛri ni furakɛli kɛcogo minnu sinsinnen bɛ daliluw kan¶

Sisan diɲɛ jamanaw ka laadilikanw ka bɔ Amerika ka sɔgɔsɔgɔninjɛ kolɛji (ACR), Erɔpu jɛkulu ka jɛkuluba (EULAR), ani British Society for Rheumatology (BSR), olu bɛ kɔrɔtɔko furakɛli fɔlɔ tila ni ɲɛnayeli walima kunkolo sɔgɔsɔgɔninjɛ bɛ yen:

Sigidaw ka kɔrɔtɔko nimɔrɔw ani baaradaw ka sariyaw¶

• Amerika ni Kanada: Aw bɛ 911 wele ni ɲɛnayeli jugumanba don walima aw bɛ taa dɔgɔtɔrɔso la min ka surun aw la Kɔrɔtɔko ɲɛmɔgɔso la ni sɔgɔsɔgɔninjɛ ni ɲɛdimi furakɛli ye. Aw bɛ Amerika ka ɲɛgɛnɛsiralabanaw ka kalanso (ACR) / jolilabanaw ka tɔnba ani Amerika ɲɛdɔnbagaw ka kalanso (AAO) ka laadilikanw labato minnu b’a ɲini aw fɛ aw ka metilprednisolone IV kɛ teliya la ka sɔrɔ ka joli siraw lajɛ.
• Royaume-Uni: Aw bɛ 999 (walima 112) wele walima ka taa Kɔrɔtɔko ɲɛmɔgɔso la / NHS ɲɛw ladonni kɔrɔtɔlen / Fast-Track GCA Clinic teliya la. NICE ani British Society for Rheumatology (BSR) Fast-Track GCA siraw kɔnɔ, banabagatɔ minnu ɲɛnayeli taamasiɲɛw bɛ u la, olu bɛ metilprednisolone sɔrɔ teliya la IV la A&E la ani ka sɔgɔsɔgɔninjɛ/ɲɛdɔgɔtɔrɔso lajɛ teliya la sanga 24 kɔnɔ.
• Erɔpu jamanaw ka tɔnba: Aw bɛ 112 wele. EULAR (European Alliance of Associations for Rheumatology) laadilikanw b’a fɔ ko glucocorticoïde tata hakɛ caman ka kan ka daminɛ joona ani ka teliya ka temporal/axillary artery ultrasound kɛ sanga 72 kɔnɔ joli sira kɛrɛnkɛrɛnnenw na.
• Ɔsitarali ani Zelande kura: Aw bɛ 000 wele Ɔsitarali walima 111 Nuwɛlika. Aw bɛ Ɔsitarali ni Nuwɛlika hakililabaarakɛlaw ka tɔnba (ANZAN) ani RANZCO (Royal Australian and New Zealand College of Ophthalmologists) kɔrɔtɔko A-AION sariyaw labato.
• Endi ni Azi Pasifiki: Aw bɛ 112 wele Ɛndujamana na, 119 Zapɔn ni Kore Dugu, walima 995 Singapuri. Hali ni GCA sɔrɔli daminɛ na ka dɔgɔn Azi jamanadenw na ka tɛmɛ Erɔpu woroduguyanfan jamanadenw kan, a bɛ kɛ tuma bɛɛ hali bi balikuw la minnu si tɛmɛna san 50 kan, wa a ka teli ka tunun walima ka mɛn aw bɛ stat ESR, CRP, ani IV steroid hakɛ caman jateminɛ ɲini k’a jɛya baliku kɔrɔba o kɔrɔba la, kungolodimi kura bɛ min na, ni a dawolo bɛ sɔgɔsɔgɔ, ani ni a ɲɛnayeli tɛ.

Aw ye a lajɛ kɔrɔtɔko nimɔrɔw ka ɲɛsin diɲɛ cikanw nimɔrɔw bɛɛ ma.

Ɲininkali minnu bɛ kɛ tuma caman na¶

Yala mɔgɔ min si tɛ san 50 bɔ, o bɛ se ka Temporal Arteritis (Giant Cell Arteritis) sɔrɔ wa?¶

Biyɔpisi fɛ, joli-sira-funu lakika min sɛgɛsɛgɛra, a bɛ se ka kɛ balikuw dɔrɔn de la minnu si bɛ san 50 la ka tɛmɛ o kan, banabagatɔ kɛmɛsarada la 80 ni kɔ bɛ tɛmɛ san 65 kan barisa joli siraw labɛncogo kura ni farikolo tangalanw ka kɔrɔya ka kɛɲɛ ni u si hakɛ ye, o de ka kan walasa bana ka se ka bonya. Banabagatɔ min si tɛ san 40 walima san 50 bɔ, ni a ka joli siraba funu ni bolokɔniw bɛ bɔ ɲɔgɔn na, dɔgɔtɔrɔw bɛ **Takayasu Arteritis**, carotid arteritis dissection, walima systemic vasculitides wɛrɛw jateminɛ o nɔ na.

Ni ne ye ɲɛ kelen tiɲɛ kaban ka bɔ Giant Cell Arteritis fɛ bi, yala stɛroyi minnu bɛ kɛ joli la, olu bɛna yeli segin o ɲɛ in na wa?¶

Ni ɲɛkisɛ kunkolo ye sɔgɔsɔgɔninjɛ sɔrɔ ka bɔ joli-sira-funu-banakisɛba la, farikolojidɛsɛ banbali saya bɛ kɛ joona, o la banabagatɔ kɛmɛsarada la, 4 fo 15 ɲɔgɔn dɔrɔn de bɛ ɲɛnayeli dɔɔni sɔrɔ ɲɛ min banana kaban hali ni metilprednisoloni ye jolisira fɛ teliya la. Nka, ka furakisɛ tata hakɛ caman daminɛ sisan, o ye kɔrɔtɔko ye min bɛ mɔgɔ ka ɲɛnamaya Changé pewu barisa ni furakisɛw tali teliya la, banabagatɔ kɛmɛsarada la, 50 bɛna yelibaliya u ɲɛ filanan (ɲuman) la tile 1 fo tile 7 kɔnɔ, o bɛ u to u ɲɛ fila bɛɛ fiyentɔya pewu.

Mun na ne man kan ka tile 2 makɔnɔ ka piridinizɔni tali daminɛ fo operelikɛla ka n ka temporal artery biopsy kɛli kɔfɛ?¶

Ka makɔnɔni kɛ hali lɛri 24 fo lɛri 48 ni stɛroyi tɛ walasa ka biyɔpisi to "furakɛli tɛ" o ye farati ye, wa a tɛ mako ɲɛ. Histopathologie ka sɛgɛsɛgɛliw y’a jira ko funu doncogo taamasiɲɛ, farikolokisɛba minnu bɛ nukili caman na, ani kɔnɔna lamini lamina elastikiw tiɲɛni bɛ to ka ye ka jɛya waati jolisira kogo kɔnɔ fo tile 10 fo tile 14 a dɔgɔyalenba la, furakisɛ tata hakɛ caman tali daminɛ kɔfɛ, k’a sɔrɔ lɛrɛ kelen o lɛrɛ kelen kelen bɛɛ ni stɛroyi tali tɛ, o bɛ kɛ fiyentɔya banbali ye i ɲɛɲɔgɔn na.

Mun na ne ɲinw furakɛla ma foyi sɔrɔ ne ɲinw na k’a sɔrɔ ne dawolo bɛ dimi tuma o tuma ni ne bɛ dumuni ɲimi?¶

Giant Cell Arteritis la, dawolo dimi ni i bɛ ɲimi (**jaw claudication**) o tɛ fosi ye ni i ɲinw walima i dawolo joli ye; a bɛ sɔrɔ farikolo tangalanw ka funu fɛ min bɛ ɲɛda ni ɲɛda joli siraw dɔgɔya minnu bɛ joli di i ka ɲimi fasaw ma min falen bɛ oksizɛni na. I n’a fɔ banabagatɔ senkɔniw datugulen don cogo min na, misiden bɛ kirin cogo min na taama kɔfɛ siɲɛ fila, o cogo kelen na, aw ka ɲimi farikolo yɔrɔw bɛ oksizɛni ban dumuni ɲimi kɔfɛ sekɔndi 60 kɔnɔ, a bɛ dimi fo aw ka ɲimi dabila, ani ka lasɔmi faratiba la min bɛ se ka kɛ aw ɲɛkisɛw la.

Ne ka C-Reactive Protein (CRP) ni ESR joli sɛgɛsɛgɛliw bɛ se ka kɛ cogo di ni ne ka yeli bɛ ka jɛya ka a to Tocilizumab (Actemra) tali la?¶

Tosilizumabi bɛ baara kɛ ni Interleukin-6 (IL-6) minɛbaga balili ye k’a ɲɛsin a yɛrɛ ma, o ye kemikaliya taamasiɲɛ tigitigi ye sugunɛ mago bɛ min na walasa ka C-Reactive Protein (CRP) ni fibrinogène (min bɛ ESR bila sen kan) dilan. O la, banabagatɔ min bɛ Tosilizumabi ta, a bɛ se ka kɛ ko CRP ni ESR bɛ kɛ a la pewu joli sɛgɛsɛgɛliw la hali ni Th1 joli siraw funu bɛ baara la hali bi u joli siraw la; dɔgɔtɔrɔw ka kan ka u jigi da kɛnɛyaso taamasiɲɛw kan i n’a fɔ kungolodimi, dawolodimi, walima ɲɛnayeli yeli sanni ka joli taamasiɲɛw kɛ walasa ka Tosilizumabi seginni dɔn.

Disiki ɲɛkisɛ "chalky white" kɔrɔ ye mun ye ni ɲɛdɔnbaga ye ne ɲɛ lajɛ?¶

Ɲɛkisɛlajɛ suguya min ka teli ka kɛ, min tɛ joli siraw ye (Non-Arteritic Anterior Ischemic Optic Neuropathy, walima NAION), ɲɛkisɛ kunkolo fununen bɛ kɛ i n’a fɔ pinɛ walima bilen (hyperemic) ni joli yɔrɔ misɛnninw ye minnu bɛ i n’a fɔ tasuma. Ni ɲɛdɔgɔtɔrɔ ye **ɲɛdimi jɛman, "kɛrɛnkɛrɛnnenya la" funun** ye ɲɛnayeli tiɲɛni tile fɔlɔ yɛrɛ la, o bɛ a jira ko kɔfɛla sɔgɔsɔgɔninjɛ bɛɛ bɛ sɔgɔsɔgɔ ani a ye **Arteritic AION from Giant Cell Arteritis** taamasiɲɛ klasiki ye.

Gafe minnu bɛ tali kɛ o ko la¶

• Ɲɛkisɛw ka kirinni (Central Retinal Artery Occlusion) ani Ɲɛkisɛw ka sɔgɔsɔgɔninjɛ
• Yelibaliya barikama, ɲɛkisɛw bɔli, ani ɲɛnamini jugumanba min bɛ kɛ ni ɲɛda datugulen ye
• Atɛki dɔnni (FAST) ani kɔrɔtɔko jaabi
• Sugunɛbilenni gɛlɛya ani Addison ka bana pikiri kɔrɔtɔlen

Sosow ani ɲɛmɔgɔyaso ka bilasiralikan¶

• Amerika ka sɔgɔsɔgɔninjɛ kolɛji (ACR) ani jolilabanaw ka tɔnba (Amerika): Amerika ka sɔgɔsɔgɔninjɛ kolɛji / jolilabanaw ka tɔnba ka san 2021 Ladilikan min ɲɛsinnen bɛ selilɛri belebelebaw ni Takayasu jolidɛsɛ furakɛli ma (Maz et al., Arthritis & Rheumatology; ka yamaruya di teliya la ka IV/da kɔnɔ glucocorticoïdes hakɛ caman ta ni siga kɛra dɔgɔtɔrɔso la biyɔpisi ni tosilizumabi furakɛli faralen ɲɔgɔn kan).
• Erɔpu ka jɛkuluba min bɛ sɔgɔsɔgɔninjɛ furakɛ (EULAR): EULAR ka ladilikanw ka ɲɛsin joli siraba belebelew banakisɛw furakɛli ma ani ja tali kɛli joli sirabaw la jolilabanaw la kɛnɛyaso la (Hellmich et al. / Dejaco et al., Annals of the Rheumatic Diseases; ultrasound temporal et axillaire rapide "Halo Sign" ka protocoles).
• British Society for Rheumatology (BSR, Angletɛri): British Society for Rheumatology Ladilikan min bɛ tali kɛ joli-sira-funu-banakisɛw sɛgɛsɛgɛli n’a furakɛli la (Mackie et al., Rheumatology).
• Amerika ɲɛdimi kalanso (AAO, Etazuni) ani Ameriki Woroduguyanfan ɲɛnayeli tɔnba (NANOS): Dɔgɔtɔrɔso ka fɔtaw ɲɛkisɛw ka ɲɛkisɛ ɲɛfɛla sɔgɔsɔgɔninjɛ (A-AION) furakɛli ani ɲɛkisɛ fiyentɔya ɲɔgɔn kunbɛnni kan.
• Royal College of Ophthalmologists (RCOphth, Angletɛri) ani NICE: Fast-Track Giant Cell Arteritis siraw ani ɲɛnayeli bɔnɛ jugumanba furakɛli kɔrɔtɔlen.