Giant Cell Arteritis

Question 1

What is giant cell arteritis?

Answer 1

Idiopathic vasculitis
*same clinical/ disease spectrum as PMR
*affects medium and large arteries in the head and neck

Question 2

What is the clinical presentation of GCA?

Answer 2

1. Headache
2. Scalp tenderness
3. Thickened temporal arteries
4. Jaw claudication (while talking, chewing, eating, there will be pain with that task)
5. Acute visual change
   *Acute amaurosis fugax (sudden loss of vision in one eye) or diplopia
6. Constitutional problems

Question 3

What are the ocular complications of GCA?

Answer 3

1. Transient monocular visual loss
   *due to central retinal artery occlusion (CRAO) OR
   *anterior ischemic optic neuropathy (AION)
2. Visual field defects

Question 4

What are the hallmark signs of GCA?

Answer 4

1. Headache
2. Scalp tenderness
3. Jaw claudication
4. Fever
5. Visual changes
   Honorable mention
6. Temporal artery may be nodular, enlarged, tender, or pulse less
7. Asymmetry of pulses in arms
8. Murmurs and bruits

Question 5

What is the treatment of GCA?

Answer 5

1. Start on high dose steroids (prednisone 60mg) immediately to prevent stroke or secondary eye involvement
2. Temporal artery biopsy within a week of starting steroids (DO NOT delay starting treatment)

Question 6

What is one way to confirm GCA?

Answer 6

Temporal artery biopsy

Question 7

What would be found histological in GCA?

Answer 7

1. Giant cells
2. Occlusion off lumen
   *giant cells are so inflamed there is a cut off of blood supply

Question 8

What is the treatment of GCA?

Answer 8

1. Prednisone 60mg orally daily
   *or IV is patient presents with visual disturbances
2. Maintain high dose for a month, then taper

Question 9

What is the prognosis of GCA?

Answer 9

1. Blindness (usually permanent) is common if untreated
2. Thoracic aortic aneurysm are 17 times more common in patients with GCA
   *use CT, MRI, Auscultation