Giant cell arteritis

Question 1

What is giant cell arteritis?

Answer 1

granulomatous inflammation of large arteries, esp. branches of the external carotid artery, most commonly the TEMPORAL ARTERY

Question 2

Describe the aetiology of GCA

Answer 2

UNKNOWN
More common with increasing age
Some associations with ethnic background + infections
Associated with HLA-DR4 + HLA-DRB1

Question 3

Summarise the epidemiology of giant cell arteritis

Answer 3

F > M

Mean age of onset: 65-70 yrs

Question 4

List 6 presenting symptoms of GCA

Answer 4

Subacute onset (usually over a few weeks)  
Temporal headache  
Scalp tenderness  
Jaw claudication  
Diplopia
Sudden blindness in one eye

Question 5

What 5 systemic symptoms may present with GCA?

Answer 5

Malaise
Low-grade fever
Lethargy
Weight loss
Depression

Question 6

What is the associated condition and thus symptoms that may present in GCA?

Answer 6

Symptoms of PMR: early morning pain + stiffness of muscles of the shoulder + pelvic girdle

Question 7

List 4 signs of giant cell arteritis on physical examination

Answer 7

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

Question 8

What would a blood test of GCA show?

Answer 8

High ESR

FBC: normocytic anaemia of chronic disease

Question 9

What investigation would be suitable for suspected GCA? When? What does the result mean?

Answer 9

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

Question 10

What 2 medications are prescribed for GCA? Why?

Answer 10

High dose prednisolone IMMEDIATELY to prevent visual loss (Reduce dose gradually- many are kept on a maintenance dose for 1-2 yrs)
Low dose aspirin (with PPI gastroprotection): reduces risk of visual loss, TIAs + stroke

Question 11

What would be performed annually for a patient with GCA? For how long? Why?

Answer 11

CXR
For up to 10 yrs
To look for thoracic aortic aneurysms

Question 12

List 4 possible complications of giant cell arteritis

Answer 12

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

Question 13

Describe the prognosis for GCA

Answer 13

In most, lasts for ~ 2 years before complete remission