Giant Cell Arteritis

Question 1

What is 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 and is also known as temporal arteritis.

Question 2

Key complication of GCA

Answer 2

Vision loss

High dose steroids are used immediately once a diganosis is suspected to rpevent the development of vision loss

Question 3

Risk fators for GCA

Answer 3

Strong link with polymyalgia rheumatica

Higher risk are white feamles over 50

Question 4

Main presenting features is a headache for GCA. What is the characteristics of this headache?

Answer 4

Severe unilateral headache typically around temple and forehead
Scalp tenderness my be noticed when brushing hair
Jaw claudication
Blurred or double vision
Irreversible painless complete sight loss can occur rapidly

Question 5

What are associated symptoms of GCA

Answer 5

Associated systemic symptoms:

Fever
Muscle aches
Fatigue
Weight loss
Loss of appetite
Peripheral oedema

Question 6

How can you diagnose GCA?

Answer 6

A definitive diagnosis is based on:

Clinical presentation
Raised ESR: usually 50 mm/hour or more
Temporal artery biopsy findings

Question 7

What is seen in a temporal artery biopsy?

Answer 7

Multinucleated giant cells are found on the temporal artery biopsy.

Question 8

What are additional investigations that can be done in GCA

Answer 8

• FBC may show a normocytic anaemia and thrombocytosis (raised platelets)
• LFTs can show a raised alkaline phosphatase
• increased CRP
• Duplex ultrasound of the temporal artery shows the hypoechoic halo sign

Question 9

Initial management of GCA?

Answer 9

Start steroids immediately before confirming the diagnosis to reduce the risk of permanent sight loss.
Start 40-60mg prednisolone per day.
60mg is given depending where there are jaw claudication or visual symptoms.
Review the response to steroids within 48 hours.
There is usually a rapid and significant response to treatment.

Question 10

What additional medication can be administered for GCA?

Answer 10

• Aspirin 75mg daily decreases visual loss and strokes

- Proton pump inhibitor (e.g. omeprazole) for gastric prevention while on steroids

Question 11

Referrals for GCA

Answer 11

Vascular surgeons for a temporal artery biopsy in all patients with suspected GCA
Rheumatology for specialist diagnosis and management
Ophthalmology review as an emergency same day appointment if they develop visual symptoms

Question 12

Managing a patient on steroids

Answer 12

DON’T STOP

• Dont stop takeign steroids abruptly. There is a risk fo adrenal crisis
• Sick day rules
• Treatment card
• Osteoporosis prevention with bisphosphonates and supplemtal calcium and vitamin D
• Proton pump inhibitor for gastric protection

Question 13

Early neuro-opthalmic complications for GCA

Answer 13

• vision loss

- cerebrovascular accident (stroke)

Question 14

Late complications of GCA

Answer 14

• relapses of the condition are common
• steroid related side effects and complications
• cerebrovascular accident (stroke)
• aortitis leading to aortic aneurysm and aortic dissection