CH12. Giant Cell Arteritis

Question 1

Which arteries are affected in GCA? (size)

Answer 1

Medium and large-size arteries

Question 2

Year of life where GCA is common?

Answer 2

70s-80s

Question 3

Is GCA more common in males or females?

Answer 3

Females (65-75%)

Question 4

What is the description of the pathology of GCA?

Answer 4

Granulomatous inflammation within the vessel wall of medium and large arteries

+

focal and segmental pattern

Question 5

Which arteries are affected by GCA?

Answer 5

Branches of aorta
External carotid
Ophthalmic arteries
Posterior ciliary arteries

Question 6

Because of the vessel wall inflammation, ___.

Answer 6

there is disruption of the internal elastic lamina, intimal hyperplasia, and narrowing and obliteration of the vascular lumen.

Question 7

Two distinct cell lineages are found within the walls. What are they?

Answer 7

TH1 and TH17
(as demonstrated by IFN gamma and IFN 17)

but TH1 is the predominant population

Question 8

Common symptom of GCA?

Answer 8

Headache, sometimes accompanied by scalp tenderness

Question 9

Pathomechanism of jaw claudiication?

Answer 9

Due to the inflammation of the facial branches of the external carotid

Question 10

Differential diagnosis for jaw claudication?

Answer 10

temporomandibular arthropathy

Question 11

Most dreaded complication of GCA?

Answer 11

Permanent loss of vision

Question 12

AION vs PION, which is more commmon?

Answer 12

AION is more common (due to affectation of posterior ciliary branches of ophthalmic artery)

PION- hypoperfusion of pial vascular plexus

Question 13

Risk of ischemic stroke in patients with GCA?

Answer 13

2.2x mostly affects the vertebrobasilar circulation

Question 14

Does GCA affect intracranial arteries?

Answer 14

Very rare! Usually the extradural segments are affected.

Question 15

What protein is increased in GCA?

Answer 15

Elastin in the adventitial tissue

Question 16

Paradoxically, this has been found to be protective against GCA.

Answer 16

Anemia, maybe due to increased tissue angiogenesis

Question 17

Other manifestations of GCA?

Answer 17

Scalp necrosis
Tongue claudication
Limb ischemia
Mesenteric ischemia
Pericardial effusion
Respiratory symptoms
Aortic vessel disease
SIADH

Question 18

What is the definitive diagnosis of GCA?

Answer 18

Temporal arterial biopsy

Question 19

American College of Rheumatology classification criteria for GCA (5)?

Answer 19

1. age of onset > 50 years
2. new headache
3. tenderness on palpation/ pulsation unrelated to arteriosclerosis
4. elevated ESR (>=50mm/hr)
5. TAB: vasculitis with predomiinance of mononuclear-cell infiltrate or granulomatous inflammation

Question 20

Unlike ESR, this inflammatory marker is not affected by age or hematologic disorders and appear to be more sensitive in the detection of GCA?

Answer 20

CRP

Question 21

Finding in Color Doppler Ultrasonography in GCA?

Answer 21

Halo sign- hypoechoic rim surrounding the artery

Also known to be most sensitive and specific finding on ultrasonography

Question 22

PET/CT imaging finding in GCA?

Answer 22

Increased due to metabolically active inflammatory cells within GCA

Question 23

To increase the yield of TAB, how long should the artery segments be?

Answer 23

1.5- 2cm long