Chewing Gum Test Unmasks Jaw Claudication of Giant Cell Arteritis Interview with:
Chih-Hung Kuo, M.B., B.S.
Peter McCluskey, M.D.
Clare L. Fraser, M.B., B.S.
University of Sydney
Sydney, NSW, Australia What is the background for this study? What are the main findings?

Response: Giant cell arteritis is a life and sight threatening systemic inflammatory condition, which remains difficult to diagnose. Jaw claudication (cramping of muscle from ischemia) is a highly specific symptom with significant diagnostic and prognostic (risk of permanent blindness) values. The reporting of jaw symptoms may be affected by many factors, such as diet. There remains no standardized clinical test available for clinicians. We study the use of chewing gum as a standardized test (like a stress test for angina pain) to better characterize this critical symptom.

The pilot study of two cases with abnormal results were published in the New England Journal of Medicine. Chewing gum at a rate of 1 chew/second can reproduce the jaw claudication symptom around 2-3 minutes. In one case, the jaw claudication was unmasked by the test with a subsequent positive biopsy result. The test result became negative after corticosteroid treatment. What should readers take away from your report?

Response: In elderly population, jaw claudication symptom reporting may be vague and dependent on many factors. A simple and repeatable chewing gum test would help to characterize the nature of the jaw complaints and may unmask the jaw claudication in patients with giant cell arteritis. The validity of this clinical test should be further investigated. Readers are encouraged to perform this simple and informative assessment on patients with suspected giant cell arteritis ( or subsequently diagnosed giant cell arteritis) and report the results in the literature.

On the same note, reader should be aware that this test is still under investigation so no clinical decision should be made on the result of this test alone, for example a negative test does not exclude a true jaw claudication or giant cell arteritis at this stage. What recommendations do you have for future research as a result of this study?

Response: We are currently conducting more studies to define and assess the validity of this clinical test and also whether the test can reliably differentiate true jaw claudication in giant cell arteritis from other causes of jaw symptoms. Thank you for your contribution to the community.


Chewing Gum Test for Jaw Claudication in Giant-Cell Arteritis
N Engl J Med 2016; 374:1794-1795May 5, 2016DOI: 10.1056/NEJMc1511420

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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