Giant Cell Arteritis

Question 1

What is Giant Cell Arteritis?

Answer 1

A systemic vasculitis of the medium and large arteries - the temporal arteries.

Question 2

Association of Giant Cell Arteritis.

Answer 2

Polymyalgia Rheumatica : 50% of GCA cases have features of PMR.

Question 3

Investigations of Giant Cell Arteritis (4).

Answer 3

1. Definitive Diagnosis : Clinical Presentation, Raised ESR (+ CRP) and Temporal Biopsy Findings (Multinucleated Giant Cells - Skip Sections of Artery).
2. FBC : Normocytic Anaemia and Thrombocytosis.
3. LFT : Raised ALP.
4. Duplex US of Temporal Artery : Hypoechoic Halo Sign.

Question 4

Management of Giant Cell Arteritis (5).

Answer 4

1. Start Steroids immediately (before biopsy) : 40-60mg Prednisolone per day (60 if jaw/visual symptoms) - before investigations.
2. Review response within 48 hours.
3. Other : Aspirin 75mg (reduce early complications) + PPI for Gastric Protection + IV Methylprednisolone (prior to High-Dose Prednisolone) if evolving visual loss.
4. Vascular Surgery (Biopsy), Rheumatology (if specialist required), Ophthalmology (if visual) Referrals.
5. Don’t STOP management and weaning over several years.

Question 5

Early Complications of Giant Cell Arteritis (2).

Answer 5

1. Vision Loss - often irreversible : high-dose steroids are used immediately once a diagnosis is suspected.
2. Cerebrovascular Accident (Stroke).

Question 6

Late Complications of Giant Cell Arteritis (4).

Answer 6

1. Relapses of GCA.
2. Steroid Side Effects.
3. Cerebrovascular Accident (Stroke).
4. Aortitis (Aortic Aneurysm + Aortic Dissection).

Question 7

Clinical Features of Giant Cell Arteritis (5).

Answer 7

1. Severe Unilateral Headache around Forehead/Temple.
2. Scalp Tenderness (e.g. when brushing hair) (Tender Palpable Temporal Artery).
3. Jaw Claudication.
4. Blurred or Double Vision.
5. Irreversible Painless Complete Loss of Vision.