Giant Cell Arteritis

Question 1

Define Giant Cell Arteritis?

Answer 1

Granulomatous inflammation of large arteries, particularly branches of the external carotid artery, most commonly the TEMPORAL ARTERY

Question 2

What is the aetiology of Giant Cell Arteritis?

Answer 2

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

Question 3

What is the epidemiology of Giant Cell Arteritis?

Answer 3

More common in FEMALES

Peak age of onset: 65-70 yrs

Question 4

What are the presenting symptoms of Giant Cell Arteritis?

Answer 4

Subacute onset (usually over a few weeks)
Headache 
Scalp tenderness 
Jaw claudication 
Blurred vision
Sudden blindness in one eye 
Systemic symptoms 
Symptoms of Polymyalgia rheumatica

Question 5

What are the systemic symptoms of Giant Cell Arteritis?

Answer 5

Malaise 
Low-grade fever 
Lethargy 
Weight loss 
Depression

Question 6

What are the symptoms of Polymyalgia Rheumatica in Giant Cell Arteritis?

Answer 6

Early morning pain and stiffness of muscles of the shoulder and pelvic girdles
40-60% of Giant Cell Arteritis has Polymyalgia rheumatica

Question 7

What are the signs of Giant Cell Arteritis?

Answer 7

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

Question 8

What bloods do we do for Giant Cell Arteritis?

Answer 8

High ESR

FBC - normocytic anaemia of chronic disease

Question 9

What do we see on Temporal Artery Biopsy for Giant Cell Arteritis?

Answer 9

Must be performed within 48 hrs of starting corticosteroids

Negative biopsy doesn’t necessarily rule out GCA

Question 10

What is the management plan for Giant Cell Arteritis?

Answer 10

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

Question 11

What are the complications of Giant Cell Arteritis?

Answer 11

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

Question 12

Why do we do a MRI for Giant Cell Arteritis?

Answer 12

Allows assessment of root and cord compression

Helps exclude spinal cord tumour and nerve root infiltration by granulomatous tissue

Question 13

What is the prognosis for patients with Giant Cell Arteritis?

Answer 13

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