Giant cell arteritis

Question 1

Define giant cell arteritis

Answer 1

Granulomatous inflammation of large arteries, particularly branches of the external carotid artery, most commonly the TEMPORAL ARTERY

Question 2

Explain the aetiology/risk factors of giant cell arteritis

Answer 2

UNKNOWN
More common with increasing age

Some associations with ethnic background and infections

Associated with HLA-DR4 and HLA-DRB1

Associated with polymyalgia rheumaticia

Question 3

Summarise the epidemiology of giant cell arteritis

Answer 3

More common in FEMALES

Peak age of onset: 65-70 yr

Question 4

Recognise the presenting symptoms of giant cell arteritis

Answer 4

Subacute onset (usually over a few weeks)

Headache
Scalp tenderness
Jaw claudication
Blurred vision
Sudden blindness in one eye

Systemic: malaise, low-grade fever, lethargy,
weight loss, depression

Symptoms of polymyalgia rheumatica -
early morning pain and stiffness of muscles of the shoulder and pelvic girdle

NOTE: 40 - 60% of GCA has polymyalgia rheumaticia

Question 5

Recognise the signs of giant cell arteritis on physical examination

Answer 5

Swelling and erythema overlying the temporal artery

Scalp and temporal tenderness

Thickened non-pulsatile temporal artery

Reduced visual acuity

Question 6

Identify appropriate investigations for giant cell arteritis

Answer 6

Bloods
High ESR
FBC - normocytic anaemia of chronic disease

Temporal Artery Biopsy
Must be performed within 48 hrs of starting corticosteroids
Negative biopsy doesn’t necessarily rule out GCA

Question 7

Generate a management plan for giant cell arteritis

Answer 7

High dose oral prednisolone IMMEDIATELY to prevent visual loss

Reduce the dose of prednisolone gradually

Many patients will need to be kept on a maintenance dose of prednisolone for 1-2 yrs

Low dose aspirin (with PPIs and gastroprotection) - reduces risk of visual loss, TIAs and stroke

Annual CXR for up to 10 yrs to look for thoracic aortic aneurysms

Question 8

Identify possible complications of giant cell arteritis

Answer 8

Carotid artery aneurysms

Aortic aneurysms

Thrombosis

Embolism to the ophthalmic artery leading to visual disturbance and loss of vision

Question 9

Summarise the prognosis for patients with giant cell arteritis

Answer 9

In most cases the condition will last for around 2 years before complete remission