Giant Cell Arteritis Flashcards
Describe GCA
Common form of systemic vasculitis in adults
Who is affected by GCA?
older patients
What is the histopathology of GCA?
Transmural inflammation of the intima, media and adventitia of affected arteries
Patch infiltration by lymphocytes, macrophages, and multinucleate giant cells
What is the result of vessel wall thickening?
Arterial luminal narrowing, resulting in sub sequential distal ischaemia
What are the common signs and symptoms of GCA?
Visual disturbances Headache Jaw claudication Scalp tenderness Fatigue Malaise Fever
When should GCA always be considered?
In patients with new-onset headache >50yrs with elevated ESR, CRP or PV
How many patients with GCA will be affected by visual symptoms?
50%
Describe the headache
Continuous, located in the temporal or occipital areas
Focal tenderness on palpation
Scalp tenderness when hair combing
What is jaw claudication?
Fatigue or discomfort of the jaw muscles during chewing of firm foods such as meat or prolonged speaking.
What causes jaw claudication?
Ischaemia of the maxillary artery
How is GCA diagnosed?
Inflammatory markers almost always raised
Temporal artery biopsy
What is the problem with temporal artery biopsies?
Low sensitivity due to patchy involvement of the artery- some segments may be normal
What are typical temporal artery biopsy findings?
Mononuclear infiltration or granulomatous inflammation, usually with multinucleate giant cells
What is the mainstay of GCA treatment?
Corticosteroids
-prednisolone 40mg if no visual impairment, 60mg if visual symptoms
Should be started as soon as suspected, not waiting for biopsy
How long does a flare last?
Prednisolone tapered over 2 years, majority will resolve over this period
