GCA Flashcards
What is the pathophysiology of GCA?
The pathological mechanism seems to start when dendritic cells in the vessel wall recruit T cells and macrophages to form granulomatous infiltrates.
Giant-cell indicates the union of several distinct cells to form a granuloma, therefore this is a granulomatous large vessel vasculitis.
What type of individual does GCA occur in?
- Elderly
- Those with PMR
How does GCA present?
- Fever
- Temporal/Generalised headache
- Scalp tenderness
- Jaw Claudication - can also get tongue claudication
- Sudden painless blindness - amaurosis fugax (occlusion of the opthalmic artery)
- Dyspnoea
- Morning stiffness
- Unequal/weak pulses
How would you investigate suspected GCA?
Bloods
- ESR + CRP - increased
- Platelets - increased
- Alk Phos - increased
- Hb - decreased - normocytic normochromic
- Albumin - low
Diagnosis
- Temporal Artery Biopsy - within 7 days of starting steroids
How would you treat someone with suspected GCA?
- High Dose Steroids - Prednisolone 60-100mg/day - immediately
- Calcium and Vitamin D
- PPI
What is are potential complications of GCA?
- Sudden painless irreversible mono/bilateral blindness
- Aortic dissection
- Aortic Aneurysm
What diagnosis would you consider if someone presented with symptoms of GCA but they were <55yrs?
Takayasu’s arteritis
What are histological features of GCA?
- Intimal hypertrophy
- Inflammation of the intima
- Degredation of the internal elastic lamina
- Giant cells, lymphocytes and plasma cells in the internal elastic lamina
How long does it normally take to resolve GCA?
12-36 months
What dose of steroids would you start someone on with GCA?
60-100 mg/day oral
If symptoms of GCA resolved on treatment, what would you consider doing?
Decreasing, but NOT stopping steroids
