Giant Cell Arteritis Flashcards
Definition
Granulomatous inflammation of large arteries, particularly branches of the external
carotid artery, most commonly the TEMPORAL ARTERY
Aetiology
- UNKNOWN
- More common with increasing age
- Some associations with ethnic background and infections
- Associated with HLA-DR4 and HLA-DRB1
Epidemiology
- More common in FEMALES
* Peak age of onset: 65-70 yrs
Presenting symptoms
• 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
o NOTE: 40-60% of GCA has polymyalgia rheumatica
Signs on physical examination
- Swelling and erythema overlying the temporal artery
- Scalp and temporal tenderness
- Thickened non-pulsatile temporal artery
- Reduced visual acuity
Investigations
• Bloods
o High ESR
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
• MRI
o Allows assessment of root and cord compression
o Helps exclude spinal cord tumour and nerve root infiltration by granulomatous tissue
• Needle Electromyography (EMG)
Management plan
- 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
Possible complications
- Carotid artery aneurysms
- Aortic aneurysms
- Thrombosis
- Embolism to the ophthalmic artery leading to visual disturbance and loss of vision
Prognosis
In most cases the condition will last for around 2 years before complete remission
