Giant Cell Arteritis

Question 1

Define

Answer 1

DEFINITION: granulomatous inflammation of large arteries, particularly branches of the external carotid artery, most commonly the TEMPORAL ARTERY

Question 2

Causes

Answer 2

UNKNOWN

Question 3

Epidemiology

Answer 3

More common in FEMALES

Peak age of onset: 65-70 yrs

Question 4

Risk factors

Answer 4

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

Question 5

Symptoms

Answer 5

Classical presentation:

• Unilateral/bilateral frontal headaches
• Pain reproduced by pressing on temples
• Temporal artery thickened and pulseless
• Jaw claudication (pain on chewing)
• Amaurosis Fugax (painless mononuclear visual loss)

Subacute onset, usually over a few weeks

• Headache: Scalp and temporal tenderness (pain on combing hair)
• Jaw and tongue claudication
• Visual disturbances: Blurred vision, sudden blindness in one eye (Amaurosis fugax)
• Systemic features: Malaise, low-grade fever, lethargy, weight loss, depression
• Symptoms of polymyalgia rheumatica: Early morning pain and stiffness of the muscles of the shoulder and pelvic girdle (40–60% associated with PMR).

Question 6

Signs

Answer 6

Swelling and erythema order temporal artery

• Scalp and temporal tenderness
• Thickened non-pulsatile temporal artery
• ↓Visual acuity

Question 7

Investigations

Answer 7

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 8

Management

Answer 8

Risk of irreversible bilateral visual loss so start STAT steroids

(1) Without visual/limb involvement STAT high dose oral prednisolone
(2) With visual/limb involvement STAT IV methylprednisolone

• Lower dose of steroid gradually according to symptoms
• Also give: low dose aspirin (with PPI gastro-protection) to ↓risk of visual loss/ stroke/TIA
• Osteoporosis prevention with ↑dietary Ca2+ and vitamin D, bisphosphonates

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