Giant cell arteritis

Question 1

Pathophysiology

Answer 1

• Chronic vasculitis of large & med sized vessels
  
  • particularly of the branches arising from the aortic arch (i.e. carotids)
• Initial factors (e.g. possible infections) → activates an immune response from certain toll-like receptors → activated monocytes subsequently producing the cytokines (e.g. IL-6) = increased ESR & CRP

Question 2

Histology

Answer 2

• Fused cells => giant cells
• T lymphocytes & macrophages w/ multinucleated giant cells
  
  • giant cell = only in 1/2 of temporal artery biopsy
• Intimal thickening, elastic lamina fragmentation
• possible thrombosis developing at the inflammatory site

Question 3

Aetiology

Answer 3

• >50 y.o
• diagnosed age ~ 72

Question 4

Examination

Answer 4

• If possible, palpate arteries
  
  • normal = pulsating & non-tender
  • otherwise = tender & non-pulsating
• Check jaw claudication (i.e. pain while chewing)
• Possible scalp + tongue involvement (necrosis)

Question 5

Investigation

Answer 5

CRP & ESR (blood test)

Question 6

Importance

Answer 6

• Blindness - but v. treatable
  
  • treat w/ steroids
• Unilateral or bilateral
• CAN occur with sudden onset
• Due to anterior ischemic optic neuropathy