AAION/GCA Flashcards
What disease is GCA associated with? What % of GCA patients have it?
Polymyalgia Rheumatica (PMR) - 50% of GCA patients
GCA attacks what type of vessels?
Medium and large sized arteries
What are the sxs of GCA?
- Fever
- HA
- Malaise/Weight Loss
- Scalp tenderness
- Jaw claudication
A headache from GCA is worse in what 2 conditions?
- At night
2. Exposure to cold
What are the 5 patient/clinical findings of GCA?
- Elderly age (>50)
- HA
- Temp. Art. Abnormality
- Elevated ESR
- Abnormal Artery Biopsy
What % of GCA patients present with ocular involvement?
50%
What are the 4 main ocular symptoms of GCA patients?
- Visual Loss
- Amaurosis Fugax
- Diplopia
- Eye Pain
What percent of amaurosis fugax cases precede permanent visual loss in GCA patients?
50-65%
AAIONs cause what % of GCA cases?
81%
Occult GCA makes up what % of GCA cases?
21%
What are the 5 lab tests for a GCA workup?
- ESR Westergran
- CRP
- CBC w/ diff
- Platelet Count
- FA
What is the norm for ESR?
Men = Age/2 Women = (Age + 10)/2
What is the norm for CRP?
< 2.54mm/dL
If elevated ESR and CRP, what % specificity is that for GCA?
97%
What are the norm values for hemoglobin?
Men = 14-18 Women = 12-16
A delay in choroidal filling time is significant for GCA when what is absent?
Carotid occlusion is absent
What’s the max choroidal filling time?
18 secs
In what time span should a GSTA biopsy be done?
within 14 days
Positive biopsies are found in what % of GCA pts?
70%
If vision is affected in one eye, what is the tx?
- IV Methylprednisolone
2. Followed by oral prednisone taper
If vision is not affected, what is the tx?
Oral prednisone 60-80mg daily
What is the newest treatment for GCA?
Actemera (Tocilizumab)
What type of injection is Actemera?
sub-cutaneous injection
What receptor does it target?
IL-6 receptor
GCA specifically targets arteries with ____. What’s the inciting antigen?
- w/ ILM
- Elastin is inciting antigen
What 3 cytokines are associated w/ systemic inflammation?
- IL-1
- IL-6
- TNF-alpha
GCA most often attacks which branch from the common carotid?
External carotid artery
- specifically targets extra-cranial carotid branches
What 2 GCA symptoms are most predictive for a + temporal artery biopsy?
- Jaw cludication
2. Neck pain
When GCA affects the choroid, what is this called?
Choroidal Hypoperfusion associated w/ delayed choroidal fillling of FA
What is the only definitive test and gold standard for testing of GCA?
Temporal artery biopsy
What are the main 2 things we’re looking for after a temporal artery biopsy?
- Internal elastic lamina fragmentation
2. Giant Cells
What increases the risk of negative GSTA biopsy ?
Skip lesions
