Delays in diagnosing giant cell arteritis (GCA) could be a result of confusion surrounding jaw symptoms, UK researchers have warned.
Having analysed interview transcripts from 36 patients in the UK and Australia with a confirmed diagnosis of GCA, the investigators found that most patients (58%) reported a diverse range of jaw symptoms that often went beyond ‘textbook’ claudication and, in some cases, were misattributed to other causes.
“People with GCA reported not only jaw claudication but also jaw stiffness and difficulties with mouth opening that affected many important everyday functions,” the authors said.
Stiffness’ or difficulty opening the mouth suggests that the temporomandibular joint itself can be affected by GCA and that this is possibly an ischaemic phenomenon. However, according to the paper, it remains unclear whether this has the same diagnostic and treatment implications as jaw claudication in patients with the condition.
The study, published in Rheumatology Advances in Practice (link here), identified five key themes within the symptoms of GCA experienced in the jaw:
- Physical sensations, including aches, cramps, stiffness and ‘lockjaw’;
- Impact on function, such as difficulty in eating/chewing, cleaning teeth, speaking or opening the mouth;
- Impact on diet, including a switch to softer food or eating less to counter symptoms;
- Symptom response with glucocorticoid therapy (not always immediate); and
- Attribution to other causes, such as arthritis, age, dental cavity or ear infection.
“In the context of previous literature, it appears likely that these are part of the spectrum of GCA symptoms of which clinicians, including dentists and ophthalmologists, should be aware,” the authors said.
However, “confirmation of this suggestion and investigation of the implications for disease stratification and treatment require further research,” they stressed.