Giant cell arteritis Flashcards
Define giant cell arteritis
Granulomatous inflammation of large arteries, particularly branches of the external carotid artery, most commonly the TEMPORAL ARTERY
Aetiology of giant cell arteritis
4
UNKNOWN
More common w/ increasing age
Some associations w/ ethnic background & infections
Associated w/ HLA-DR4 & HLA-DRB1
Epidemiology of giant cell arteritis
gender, age
More common in FEMALES
Peak age on onset 65-70 yrs
Presenting symptoms of giant cell arteritis
8
Subacute onset (usually over a few weeks)
Headache
Scalp tenderness
Jaw claudication
Blurred vision
Sudden blindness in 1 eye
Systemic - malaise, low grade fever, lethargy, weight loss, depression
Symptoms of polymyalgia rheumatica
- early morning pain & stiffness of muscles of shoulder & pelvic girdle
Signs of giant cell arteritis on physical examination
4
Swelling & erythema overlying temporal artery
Scalp & temporal tenderness
Thickened non-pulsatile temporal artery
Reduced visual acuity
Investigations for giant cell arteritis
2 types
Bloods
Temporal artery biopsy
Investigations for giant cell arteritis - bloods
2
High ESR
FBC - normocytic anaemia of chronic disease
Investigations for giant cell arteritis - temporal artery biopsy
(2)
Must be performed within 48 hrs of starting corticosteroids
Negative biopsy doesn’t necessarily rule out GCA
Management of giant cell arteritis
5
High dose oral prednisolone IMMEDIATELY to prevent visual loss
Reduce dose gradually
Many patients need to be kept on maintenance dose of prednisolone for 1-2 yrs
Low dose aspirin (w/ PPIs & gastric protection) - reduces risk of visual loss, TIAs & stroke
Annual CXR for up to 10 yrs to look for thoracic aortic aneurysms
Complications of giant cell arteritis
4
Carotid artery aneurysms
Aortic aneurysms
Thrombosis
Embolism to ophthalmic artery leading to visual disturbance & loss of vision
Prognosis of giant cell arteritis
Most cases condition lasts for around 2 yrs before complete remission
