Evidence map›Paper›PMID 39482474›Full record

SynthesisJournal of general internal medicine2025

Atypical Signs and Symptoms of Giant Cell Arteritis: A Systematic Review.

Irina Sverdlichenko, Jim Shenchu Xie, Brianna Lu, Brendan Tao, Abbie Lai, Sumana Naidu, Jovi Wong, Armin Handzic, Jonathan Micieli, Edward Margolin

Abstract readSystematic Review
In one paragraph

Synthesis in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Irina SverdlichenkoFaculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Jim Shenchu XieMichael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Brianna LuFaculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Brendan TaoFaculty of Medicine, University of British Columbia, Vancouver, Ontario, Canada.
Abbie LaiMichael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Sumana NaiduDepartment of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Jovi WongDepartment of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Armin HandzicDepartment of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Jonathan MicieliDepartment of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Edward MargolinDepartment of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. edward.margolin@uhn.ca.ORCID 0000-0002-6738-7225

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGiant cell arteritis can present with atypical manifestations that delay treatment and risk severe complications.

objectivesTo comprehensively describe all atypical signs/symptoms of giant cell arteritis.

designIn this systematic review, we searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to October 2022. Primary research articles that included at least one participant with an atypical sign/symptom of biopsy-proven giant cell arteritis were included. Study screening and data extraction were performed in duplicate. The primary outcome was the proportion of participants with atypical giant cell arteritis features. Time to treatment was compared between participants with atypical giant features only and participants with both typical and atypical features.

resultsOf 21,828 screened records, 429 studies corresponding to 746 individuals (median [IQR] age 72 [IQR, 66-78] years, 63% female) with at least one atypical feature of GCA were included. Eighty-two percent had both atypical and at least one concurrent typical giant cell arteritis feature, whereas 18% of patients with atypical signs and symptoms only presented with atypical features. Patients with atypical symptoms presented to clinicians earlier than patients with typical features (p < 0.001). There was no difference between groups in proportion to elevated ESR and CRP (82.3% vs. 83.35%, p = 0.91) or mortality rate (8.2% vs. 10.8%, p = 0.42). Patients with atypical features only experienced greater delay in treatment initiation (p < 0.001). The most commonly reported atypical signs/symptoms were vertigo (11.9%), scalp necrosis/ulceration (7.9%), and dry cough (5.8%).

conclusionsEighteen percent of biopsy-proven giant cell arteritis cases with at least one atypical feature have only atypical features and are more likely to experience delays in treatment. Clinicians should be aware of atypical signs/symptoms of giant cell arteritis and order inflammatory markers early to prevent giant cell arteritis-associated morbidity.

Indexed as

Giant Cell ArteritisHumansbiopsydifferential diagnosisgiant cell arteritistemporal arteries

Identifiers

PMID39482474
PMCPMC11861792

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.