期刊
JOURNAL OF RHEUMATOLOGY
卷 48, 期 7, 页码 1053-1059出版社
J RHEUMATOL PUBL CO
DOI: 10.3899/jrheum.200766
关键词
coronavirus; diagnosis; giant cell arteritis
类别
资金
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) [T32 AR007611-13]
- Vasculitis Clinical Research Consortium (VCRC)/Vasculitis Foundation Fellowship
- NCATS
- NIAMS [U54 AR057319]
- MRC TARGET Partnership Grant [MR/N011775/1/MRC]
- NIHR Leeds Biomedical Research Centre
Common features of giant cell arteritis (GCA) and coronavirus disease 2019 (COVID-19) include headache, fever, elevated CRP, and cough. However, jaw claudication, visual loss, platelet count, and lymphocyte count may be more discriminatory. Physicians should be cautious of potential diagnostic confusion and use a simple checklist for evaluation of suspected GCA patients.
Objective. To identify shared and distinct features of giant cell arteritis (GCA) and coronavirus disease 2019 (COVID-19) to reduce diagnostic errors that could cause delays in correct treatment. Methods. Two systematic literature reviews determined the frequency of clinical features of GCA and COVID-19 in published reports. Frequencies in each disease were summarized using medians and ranges. Results. Headache was common in GCA but was also observed in COVID-19 (GCA 66%, COVID-19 10%). Jaw claudication or visual loss (43% and 26% in GCA, respectively) generally were not reported in COVID-19. Both diseases featured fatigue (GCA 38%, COVID-19 43%) and elevated inflammatory markers (C-reactive protein [CRP] elevated in 100% of GCA, 66% of COVID-19), but platelet count was elevated in 47% of GCA but only 4% of COVID-19 cases. Cough and fever were commonly reported in COVID-19 and less frequently in GCA (cough, 63% for COVID-19 vs 12% for GCA; fever, 83% for COVID-19 vs 27% for GCA). Gastrointestinal upset was occasionally reported in COVID-19 (8%), rarely in GCA (4%). Lymphopenia was more common in COVID-19 than GCA (53% in COVID-19, 2% in GCA). Alteration of smell and taste have been described in GCA but their frequency is unclear. Conclusion. Overlapping features of GCA and COVID-19 include headache, fever, elevated CRP and cough. Jaw claudication, visual loss, platelet count and lymphocyte count may be more discriminatory. Physicians should be aware of the possibility of diagnostic confusion. We have designed a simple checklist to aid evidence-based evaluation of patients with suspected GCA.
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