Giant cell Arteritis

Question 1

Define:

Answer 1

• Granulomatous inflammation of large arteries affecting branches of the external carotid artery, most commonly the TEMPORAL ARTERY
• A type of VASCULITIS

Question 2

Aetiology/risk factors:

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 rheumatic in 50%

Question 3

Epidemiology:

Answer 3

• More common in FEMALES
• Peak age of onset: 65-70 yrs
• If under 55, consider Takayasu’s

Question 4

Symptoms:

Answer 4

• Subacute onset (usually over a few weeks)
• Headache
• Scalp tenderness i.e. when brushing hair
• 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

Question 5

Signs:

Answer 5

• Swelling and erythema overlying the temporal artery
• Scalp and temporal tenderness
• Thickened non-pulsatile temporal artery
• Reduced visual acuity

Question 6

Investigations:

Answer 6

o High ESR and high CRP
o High platelets
o High ALP
o FBC - normocytic anaemia of chronic disease
• Temporal Artery Biopsy
o Must be performed within 48 hrs of starting corticosteroids
o Negative biopsy doesn’t necessarily rule out GCA as GCA is segmental (skip lesions)

Question 7

What is the criteria to diagnosing:

Answer 7

must have 3 of the following:
o Age of onset of symptoms > 50 years
o New headache
o ESR >50mm/h
o Clinically abnormal temporal artery – tender or non-pulsatile
o Biopsy of temporal artery showing mononuclear cell infiltration or granuloma (giant cells)

Question 8

Management:

Answer 8

• High dose oral prednisolone 60mg/d PO IMMEDIATELY to prevent visual loss is suspected, then do ESR
• Reduce the dose of prednisolone gradually as symptoms resolve and ESR drops
• Many patients will need to be kept on a maintenance dose of prednisolone for 2 yrs until complete remission
• Low dose aspirin with PPIs and biphosphonates – gastric and bone protection, reduces risk of visual loss, TIAs and stroke
• Annual CXR for up to 10 yrs to look for thoracic aortic aneurysms

Question 9

Complications:

Answer 9

• Carotid artery aneurysms
• Aortic aneurysms
• Thrombosis
• Embolism to the ophthalmic artery leading to visual disturbance and loss of vision

Question 10

Prognosis:

Answer 10

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