Giant Cell Arteritis

Question 1

define GCA

Answer 1

• Giant cell arteritis is a systemic vasculitis of the medium and large arteries. It typically presents with symptoms affecting the temporal arteries.

Question 2

RF for GCA

Answer 2

female and >50 years

Question 3

Sx of GCA

Answer 3

• Severe unilateral headache typically around temple and forehead
• Scalp tenderness (usually when brushing hair)
• Jaw claudication
• Blurred or double vision
• Irreversible painless complete sight loss can occur rapidly.

Question 4

Systemic Sx of GCA

Answer 4

• Fever
• Muscle aches
• Fatigue
• Weight loss
• Loss of appetite
• Peripheral oedema

Question 5

How is GCA diagnosed?

Answer 5

1) Clinical presentation
2) ESR raised
3) Temporal artery biopsy

Question 6

what do you see on biopsy for GCA?

Answer 6

Multinucleated giant cells are found on temporal artery biopsy.

Question 7

What additional investigations would you for GCA?

Answer 7

• FBC  normocytic anaemia and thrombocytosis
• LFTs  raised ALP
• CRP raised
• U/S  hypoechoic halo sign.

Question 8

initial management of GCA?

Answer 8

1) Steroids
- Start 40-60mg OD, dependeng on whether there is claudication or visual symptoms
- Review in 48 hours
2) Aspirin 75mg OD
3) PPI due to steroids

Question 9

who to refer for GCA?

Answer 9

• Vascular surgeons for biopsy
• Rheumatology for Dx and Mx
• Ophthalmology if visual sx

Question 10

Mx of GCA?

Answer 10

1) Stay on 40-60mg until sx resolve and slowly wean off.

2) DON’T stop advice for long term steroid use.

Question 11

complications of GCA

Answer 11

1) Early neuro-opthalmic complications  vision loss, CVA

2) Late  relapses, steroid use SE, CVA, aortitis, AAA, aortic dissection