Giant Cell Arteritis

Question 1

Giant Cell Arteritis Definition

Answer 1

Systemic immune-mediated vasculitis affecting medium sized and large-sized arteries, particularly carotid and external branches
-Polymyalgia reumatica is a different manifestation of the same disease process

Question 2

Giant Cell Arteritis Epidemiology

Answer 2

• Elderly

- Women affected two to three times more often

Question 3

Giant Cell Arteritis Presentation

Answer 3

Recent onset temporal headache, myalgia, malaise or fever

-Suspect in anyone over 50 with scalp tenderness, transient visual symptoms or unexplained facial pain

Question 4

Giant Cell Arteritis Symptoms

Answer 4

• Headache, recent onset, change in character. Temporal or occipital region described as severe by most patients
• Scalp tenderness making simple tasks e.g. combing hair or resting on pillow painful
• Jaw claudication; particularly when eating or talking (slow onset, fast onset is TMJ/dental pain)
• Visual disturbances; blurred vision amaurosis fugal, visual loss, diplopia (can all occur in absence of headache)
• Systemic symptoms similar to PMR; anorexia, weight loss, fever, sweats, malaise, fatigue, depression
• Can involve aorta and subclavian steal
• Few signs, temporal arteries may be prominent beaded tender and pulseless but can be normal

Question 5

Giant Cell Arteritis Diagnosis

Answer 5

Classification, if 3 of these are met; GCA

• Symptoms/fiindings develop ≥50 years old
• New headache
• Temporal artery abnormality
• Elevated ESR (≥50mm/hr)
• Abnormal artery biopsy

Question 6

Giant Cell Arteritis Differentials

Answer 6

Migraine, tension headaches, trigeminal neuralgia

Question 7

Giant Cell Arteritis Ix

Answer 7

• Urgent referral for temporal artery biopsy
• ESR raised in 83%
• Anaemia common
• LFTs may be elevated
• Colour duplex ultrasonography has been shown to be relatively accurate for diagnosing GCS

Question 8

Giant Cell Arteritis Management

Answer 8

• Steroids; high dose prednisolone immediately
• 40mg daily, 60mg if claudication
• If visual symptoms admit for treatment with IV methyprednisolone
• Low dose aspirin; start at 75mg daily
• Gastroprotection with PPI

Question 9

Giant Cell Arteritis Complications

Answer 9

-Permanent visual occurs in 20%
-Aneurysms
-Central nervous system
0Steroid related complications are common