Garland's triad

Garland's Triad, also known as the triad of periarteritis nodosa, is a medical condition characterized by a specific set of three clinical features. It is named after the British physician Roger Garland. The condition is closely associated with Polyarteritis nodosa, a form of vasculitis that affects medium-sized arteries, leading to their inflammation and subsequent damage. Garland's Triad is significant in the diagnosis and understanding of this complex disease.

Clinical Features

Garland's Triad consists of the following three key features:

1. Fever: Patients often present with a fever of unknown origin. This fever is typically persistent and does not respond well to standard antipyretic treatments.
2. Weight Loss: Unexplained weight loss is another hallmark of the condition, reflecting the systemic nature of the disease and its impact on the body's metabolism.
3. Hypertension: High blood pressure is the third component of the triad. It is usually severe and may be resistant to conventional antihypertensive therapies.

Pathophysiology

The pathophysiology of Garland's Triad is closely linked to the underlying mechanisms of Polyarteritis nodosa. The disease process involves an immune-mediated attack on the arterial wall, leading to inflammation, necrosis, and the formation of aneurysms. These pathological changes can compromise blood supply to various organs, contributing to the clinical manifestations observed in Garland's Triad.

Diagnosis

Diagnosis of Garland's Triad involves a combination of clinical evaluation and diagnostic tests. Key steps include:

• Clinical History and Examination: A detailed patient history and physical examination are crucial for identifying the triad's components.
• Laboratory Tests: Blood tests may reveal elevated inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
• Imaging Studies: Angiography is the gold standard for diagnosing Polyarteritis nodosa, revealing characteristic aneurysms and stenoses in affected arteries.
• Biopsy: A biopsy of affected tissue can provide definitive evidence of vasculitis.

Treatment

Treatment of Garland's Triad focuses on managing Polyarteritis nodosa and involves:

• Corticosteroids: High-dose corticosteroids are the mainstay of treatment, aiming to reduce inflammation.
• Immunosuppressive Agents: Medications such as cyclophosphamide may be used to suppress the immune response.
• Antihypertensive Therapy: Effective management of hypertension is critical and may require multiple medications.

Prognosis

The prognosis of patients with Garland's Triad depends on the severity of the underlying vasculitis and the response to treatment. Early diagnosis and aggressive therapy can significantly improve outcomes.

See Also

• Vasculitis
• Hypertension
• Fever
• Weight loss