GCA

Question 1

What is Giant Cell Arteritis (GCA)?

Answer 1

Giant Cell Arteritis (GCA), also known as temporal arteritis, is a type of systemic vasculitis affecting the medium and large arteries, with a strong link to polymyalgia rheumatica.

Question 2

Who is most commonly affected by Giant Cell Arteritis (GCA)?

Answer 2

GCA is more common in older white patients.

Question 3

What is the key complication of Giant Cell Arteritis (GCA)?

Answer 3

The key complication of GCA is vision loss, which is often irreversible if untreated.

Question 4

What is the primary presenting feature of Giant Cell Arteritis (GCA)?

Answer 4

The primary presenting feature is unilateral headache, typically severe and located around the temple and forehead.

Question 5

What are some associated symptoms of Giant Cell Arteritis (GCA)?

Answer 5

• Scalp tenderness (noticed when brushing the hair)
• Jaw claudication (pain or cramping in the jaw while chewing)
• Blurred or double vision
• Loss of vision (if untreated)

Question 6

What physical exam findings may suggest Giant Cell Arteritis (GCA)?

Answer 6

• Tenderness and thickening of the temporal artery
• Reduced or absent pulsation of the temporal artery

Question 7

What associated features are seen in Giant Cell Arteritis (GCA)?

Answer 7

• Symptoms of polymyalgia rheumatica (e.g., shoulder and pelvic girdle pain and stiffness)
• Systemic symptoms (e.g., weight loss, fatigue, and low-grade fever)
• Muscle tenderness
• Carpal tunnel syndrome
• Peripheral oedema

Question 8

What investigations are used to diagnose Giant Cell Arteritis (GCA)?

Answer 8

• Clinical presentation
• Raised inflammatory markers, especially ESR (usually >50 mm/hour)
• Temporal artery biopsy (showing multinucleated giant cells)
• Duplex ultrasound (showing the hypoechoic “halo” sign and stenosis of the temporal artery)

Question 9

What is the initial treatment for Giant Cell Arteritis (GCA)?

Answer 9

• 40-60mg of prednisolone daily if no visual symptoms or jaw claudication
• 500mg-1000mg of methylprednisolone daily if visual symptoms or jaw claudication are present

Question 10

What is the goal of steroid treatment in Giant Cell Arteritis (GCA)?

Answer 10

Steroid treatment is started immediately to reduce the risk of vision loss. There is usually a rapid and significant response to treatment.

Question 11

How is the steroid dose reduced in Giant Cell Arteritis (GCA)?

Answer 11

Once the diagnosis is confirmed and the condition is controlled, the steroid dose is slowly weaned over 1-2 years.

Question 12

What additional medications are used in the management of Giant Cell Arteritis (GCA)?

Answer 12

• Aspirin 75mg daily to decrease vision loss and strokes
• Proton pump inhibitors (e.g., omeprazole) for gastroprotection while on steroids
• Bisphosphonates and calcium/vitamin D for bone protection while on steroids

Question 13

Which specialties are involved in the management of Giant Cell Arteritis (GCA)?

Answer 13

• Rheumatology for specialist diagnosis and management
• Vascular surgeons for temporal artery biopsy
• Ophthalmology for review of visual symptoms

Question 14

What are the complications of Giant Cell Arteritis (GCA)?

Answer 14

• Steroid-related complications (e.g., weight gain, diabetes, osteoporosis)
• Visual loss
• Cerebrovascular accidents (e.g., stroke)