Giant cell arteritis

Question 1

What is it

Answer 1

Most common form of vasculitis in adults.
Arteries, particularly those at the side of the head (the temples), become inflamed.
Granulomatous arteritis.
Associated with Polymyalgia rheumatics

Question 2

Pathophysiology

Answer 2

Granulomatous arteritis, affecting in particular the extra-dural arteries and the large cerebral arteries specifically.
Arteries become inflamed, thickened and can obstruct blood flow.
AKA Chronic inflammation of the medium-large arteries, particularly the aorta and its extracranial branches.

Question 3

How can blindness result from giant cell arteritis

Answer 3

Inflammation and occlusion of the ciliary and/or central retinal artery
Ophthalmic artery can also be affected, potentially resulting in permanent or temporary vision loss

Question 4

Clinical presentation

Answer 4

Headache, scalp tenderness, jaw claudication
Superficial temporal artery may be firm, tender and pulseless
Weight loss, malaise and fever
Blindness in 25% of untreated (amaurosis fugax)

Question 5

Epidemiology

Answer 5

Principally over 50s
Females more
Caucasians more

Question 6

*Treatment

Answer 6

Corticosteroids e.g. Prednisolone
Methotrexate
Monitor and reduce likelihood of osteoporosis

Question 7

When should it be suspected

Answer 7

In all >50 year olds with a headache that has lasted a few weeks

Question 8

What is the most common form of vasculitis

Answer 8

Giant cell arteritis

Question 9

Definitive diagnostic test

Answer 9

Temporal artery biopsy (histology)

Question 10

What arteries are mainly affected

Answer 10

Chronic inflammation of the medium-large arteries, particularly the aorta and its extracranial branches
Large cerebral arteries
Extra-dural arteries
Ciliary, central Retinal, Ophthalmic arteries

Question 11

How do corticosteroids work

Answer 11

Reduce inflammation

Can bind to messenger RNA and inhibit/slow production of certain proteins

Question 12

Differential diagnoses

Answer 12

Migraine, tension headache, trigeminal neuralgia, polyarteritis nodosa

Question 13

Diagnosis

Answer 13

3 or more of:
Over 50
New headache
Temporal artery tenderness or decreased pulsation
ESR raised
Abnormal arterial biopsy (inflammatory infiltrates present)

ET ANA - ESR rasied, Temporal artery tender, Abnormal arterial biopsy, New headache, Age over 50