Giant cell arteritis

Question 1

What is giant cell arteritis?

Answer 1

Systemic vasculitis of the medium and large arteries

Question 2

Presentation of GCA

Answer 2

Unilateral headache around temple and forehead typically

Scalp tenderness

Jaw claudication

Blurred/double vision

Systemic symptoms may be seen e.g.:

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

Question 3

What is GCA associated with? What is its main complication?

Answer 3

Strongly associated with PMR

Key complication is vision loss (often irreversible)

Question 4

How is a diagnosis of GCA made?

Answer 4

Gold standard diagnostic investigation is temporal artery biopsy:
- Multinucleated giant cells finding

Clinical presentation

Raised ESR/CRP

Question 5

Management of GCA

Answer 5

• High dose 40-60mg prednisolone OD
• Review steroids within 48h, usually a rapid response to them
• Aspirin 75mg decreases visual loss and strokes
• PPI for gastric prevention while on steroids

Refer to vascular surgery for biopsy, rheumatology
- and same day ophthalmology review if any visual symptoms

High dose steroids until symptoms resolve, then slowly wean steroids

Question 6

Potential complications of GCA

Answer 6

Early:

• Vision loss
• Stroke

Later:

• Relapses are common
• Steroid related side effects
• Stroke
• Aortitis - leading to aortic aneurysm and aortic dissection