Giant Cell Arteritis

Question 1

Define giant cell arteritis

Answer 1

Granulomatous vasculitis of large and medium-sized arteries, primarily affecting the branches of the external carotid artery (temporal)

Question 2

Aetiology of giant cell arteritis

Answer 2

Unknown
HLA-DRB104 and DRB101 alleles have been associated
Infectious agents have also been implied e.g. Mycoplasma pneumoniae, parvovirus B19, parainfluenza virus, chlamydia pneumoniae, varicella-zoster

Question 3

Risk factors for Giant Cell Arteritis

Answer 3

<50
Female
Genetic factors
Smoking
Atherosclerosis
Infectious agents

Question 4

Epidemiology of Giant Cell Arteritis

Answer 4

Most common form of vasculitis in adults
Typically those 50 or older
More common in women

Question 5

Symptoms of Giant Cell Arteritis

Answer 5

Headache (subacute onset (few weeks) | temporal/occipital area, scalp)
Temporal tenderness e.g. combing hair, brushing teeth
Jaw and tongue claudication
Visual disturbances: blurred vision, sudden blindness in one eye (amaurosis fugax)
Systemic: malaise, fever, lethargy, weight loss, depression
Polymyalgia rheumatica symptoms: early morning pain and stiffness of muscles of shoulder + pelvic girdle
Cough, sore throat, hoarseness

Question 6

Signs of Giant Cell Arteritis on examination

Answer 6

Swelling and erythema of the temporal artery area
Thickened non-pulsatile temporal artery
Bruit auscultation (carotid, supraclavicular, axillary or brachial areas)
Asymmetric blood pressure
Limited active range of movement of shoulders and hips
Wrist and knee swelling

Question 7

Investigations for Giant Cell Arteritis

Answer 7

ESR: raised (>50mm/hour)
FBC: normocytic anaemia
CRP: elevated
LFTs: ALT/AST/ALP elevated

Temporal artery USS: wall thickening (Halo sign), stenosis or occlusion
Temporal artery biopsy: +ve, histopathology shows granulomatous inflammation, multinucleated giant cells (50%) (within 48hrs of starting steroids)
FDG-PET: look for inflammation

Question 8

Management for Giant Cell Arteritis

Answer 8

Any visual s/s → IV methylprednisolone + same day assessment by ophthal

1. High dose oral prednisolone to prevent visual loss (lower dose gradually according to symptoms + ESR)
2. Low dose aspirin + PPI
3. Osteoporosis prevention (calcium, vit D, bisphosphonates)
4. Annual CXR (up to 10 years) for thoracic artery aneurysms
5. Recurrent/relapsing/steroid intolerence disease -> tocilizumab, methotrexate

+ urgent specialist evaluation at least within 3 days

Question 9

Complications of Giant Cell Arteritis

Answer 9

Untreated: irreversible loss of vision (ophthalmic artery involvement)
Carotid or aortic aneurysm
Thrombosis -> recanalisation or embolism to the ophthalmic artery

Question 10

Prognosis of Giant Cell Arteritis

Answer 10

Lasts around 2 years before complete remission