Giant Cell arteritis

Question 1

What is GCA?

Answer 1

• Chronic vasculitis of large and medium sized vessels that occurs among people over 50
• Often referred to as temporal arteritis

Question 2

Median age onset GCA

Answer 2

72

Question 3

Commonly causes inflammation of….

Answer 3

• Arteries originating from arch of aorta (eg brachiocephalic, subcalvian, common carotid)

Question 4

What can occlusive arteritis result in

Answer 4

• Anterior ischaemic optic neuropathy (AION)
• Acute vision loss

Question 5

What is emergency presentation of GCA?

Answer 5

Visual changes/symptoms

Question 6

What does inflammation of arteries supplying muscles of jaw and tongue create?

Answer 6

• Jaw claudication
• Tongue discomfort

Question 7

How can GCA present acutely in another wauy?

Answer 7

Stroke

Question 8

RF for GCA

Answer 8

• Rare if under 50
• More than 90% are older than 60
• Northern latitude
• Women
• White ethnic origin
• Strong association with PMR
• HLA-DR4 - genetic predispostion

Question 9

Presentation of acute GCA

Answer 9

• Usually acute
• Headache unilateral
• Localised, unilateral stabbing sensation over temple
• Tongue or jaw claudication on mastication
• Visual findings weeks/months after onset of symptoms
• Scalp tenderness esp over temporal artery - hurt when brushing hair

Question 10

Visual symptoms of GCA

Answer 10

• Amaurosis fugax
• Blindness
• Diplopia
• Blurred vision

Question 11

Diagnosis of GCA

Answer 11

Presence of 2 or more criteria in following patients over 50:
* Raised ESR, CRP or PV
* New onset localised headache
* Tenderness or decreased pulsation of temporal artery
* New visual symptoms
* Biopsy revealing necrotizing arteritis

Question 12

Treatment of GCA

Answer 12

• Prednisolone 60-100mg PO per day for at least 2 weeks
• Before considering tapering down
• If acute visual symptoms consider 1g IV methylprednisolone pulse therapy for 1-3 days
• Low dose aspirin - reduce thronbosis risk

Question 13

Most feared complication of GCA

Answer 13

• Permanent visual loss

Question 14

When to initiate steroids?

Answer 14

Do not wait for biopsy if strong clinical suspicion for GCA or if visual changes are reported

Question 15

Which symptoms do pts often neglect to report?

Answer 15

• Jaw claudication
• Amaurosis fugax
  QUERY THEM DIRECTLY

Question 16

What does biopsy show for GCA?

Answer 16

• Giant cell granulomas
• Panarteritis
• Macrophages
• Skip lesions can occur - some biopsy can be normal, does not rule out GCA

Question 17

Other investigation for definitive diagnosis other than biopsy

Answer 17

• USS temporal artery
• See halo sign - thickened wall
• Can check axilla too to see vessels there
• ONLY +VE FOR 1 week as steroids reduce inflammation

Question 18

Why do you get jaw claudication?

Answer 18

If facial artery is affected too - reduced blood flow = cramping

Question 19

How to wean down steroids?

Answer 19

• Wean down using ESR as a guide
• Can use methotrexate as steroid sparing