Giant cell arteritis

Question 1

Giant cell arteritis presentation

Answer 1

• patient usually over 60
• rapid onset (under 1 month)
• headache, jaw claudication
• tender and palpable temporal artery
• anterior ischaemic optic neuropathy - temporary or permanent vision loss
• polymyalgia rheumatica - aching, morning stiffness but not weakness
• lethargy, depression, low-grade fever, anorexia, night sweats

Question 2

Giant cell arteritis differentials

Answer 2

• raised ICP
• herpes zoster (shingles)
• cluster headache
• migraine
• acute angle closure glaucoma

Question 3

Giant cell arteritis investigations

Answer 3

• raised inflammatory markers (ESR usually above 50)
• confirm with temporal artery biopsy (beware skip lesions)
• ultrasound may show halo sign, occlusion
• do not delay treatment to investigate

Question 4

Giant cell arteritis management

Answer 4

• no visual loss - 40-60mg prednisolone
• visual loss - pred 60-100mg oral and then methylprednisolone IV 500g to 1g
• give steroids before biopsy
• if visual loss - same day ophthal review
• bone protection with bisphosphonates due to long course of steroids