Giant Cell Arteritis

Question 1

What is Giant Cell arteritis?

Answer 1

COmmoly known as Temporal arteritis?

Question 2

What is a granuloma?

Answer 2

collection of activated macrophages (histocytes and multinucleated giant cells might also be present)

Form when immune system tries to wall of something that is perceived foreign but is unable to eliminate it

Question 3

What are the affected vessels in Giant cell arteritis?

Answer 3

• Preferably: extracranial branches of carotid artery+ branches of ophthalmic artery
• Aorta + branches might also be Affected

Question 4

What is the aetiology of Giant Cell arteritis?

Answer 4

Unknown

Question 5

What are risk factors for the development of Giant cell arteritis?

Answer 5

• Genetic factors
• Age >50
• Female
• Smoking
• Polymyaliga Rheumatica

Question 6

What is the epidemiology of Giant cell arteritis?

Answer 6

• 20/100.000
• Rare before 50 years (highest 70-80)
• More common in white
• Women

Question 7

What are the signs and symptoms of GCA?

Answer 7

• New onset localized HeadacheUnilateral in the temporal artery area (might become bilateral)
  
  • E.g. when combing hair
  • Tenderness, thickening, nodularity in Temporal artery
• Jaw claudication
  
  • Due to ischemia to muscles of mastication
• Symptoms due to: General inflammation
  
  • Fever, Fatigue, Joint pain, weight loss, anorexia, depression
• Tissue ischaemia Visual disturbance
  
  • Might lead to loss of vision
• Symptoms of PMR
• Neurological features
  
  • Mono/Polyneuropathies of arms and legs
  • TIA

Question 8

What are the possible optical complications of Giant Cell arteritis?

Answer 8

Vision loss

In about 20% with little change to recover

Question 9

What are the possible CVS complications of GCA?

Answer 9

MI, HF

Stroke

Peripheral artery disease

Question 10

What are the large artery complications of GCA?

Answer 10

Large arteries complications (27%)

• Aortic aneurism
• Aortic dissection
• Large artery stenosis
• Aortic regurgitation

Question 11

WHich investigations would you do in a patiennt with supsected GCA?

Answer 11

• Bloods
  
  • ESR (high, may be normal)
  • CRP (high)
  • Liver function
  • FBC (normocytic anaemia with elevated platelets normal)
• Temporal artery Biopsy
  
  • Looking for giant cells

Question 12

What is the treatment of GCA?

Answer 12

• Same day referral
• diet, physical activity and stopping smoking.
• Hight dose of steroids (60-100mg with visual symptoms, 40-60 without)
  
  • Osteoporosis prophylaxis (Bisphosphonates + Vit D+ Calcium)
  • PPI
  • Try to come off after 1-2 years
  • Review a week after every reduction of dose
• Bloods + monitoring of symptoms

Question 13

What is the prognosis of patients with GCA?

Answer 13

• Relapse is common (if corticosteroid reduced/ withdraw too quickly)
• 30-50% spontaneous exacerbation (especially in first 2 years), independent of corticosteroid use

Question 14

What is the pathophysiologicacl process in Giant cell arteritis?

Answer 14

• Granulomatous inflammationin combination with vasculitis
  
  • Formation of granulomas
  • IN GCA: T-cells and macrophages, multinucleated giant cells in about 50% of cases
• In outer or adventi layer of arterial wall (Structure of The Vessel)
  
  • –> Intimal expansion and hyperplasia causing occlusion of vessel lumen and ischaemia

Question 15

What are giant cells?

Answer 15

multinucleated giant cells, are multinucleatetd masses formed by the union of several distinct cells (usually histiocytes), often forming a granuloma.

Question 16

What is the association between giant cell arteritis and PMR?

Answer 16

Close relationship, 50% of PMR will also have GCA