Giant Cell Arteritis, Takasayu's

Question 1

What is a vasculitis

what is classified using?

Answer 1

inflammatory disorder of the blood vessels,

commonly classified using the modified chapel hill criteria

can affect any organ, presentation depends on organ involved. may be a primary condition or secondary to others e.g SLE, RA, Hepatitis B&C, HIV

Question 2

What are examples of large blood vessel vasculitis?

Answer 2

• Giant cell arteritis

- Takayasu’s arteritis

Question 3

What are examples of medium vessel vasculitis?

what are variable vessel vasculitis?

Answer 3

• Polyarteritis nodosa
• Kawasaki disease

Behcet’s

Question 4

What are examples of small vessel vasculitis and what can they be categorised into?

Answer 4

ANCA associated

• Microscopic polyangiItis (p-ANCA)
• Granulomatosis with polyangiitis (Wegner’s granulomatosis) (c-ANCA)
• Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

Immune complex mediated

• Goodpasture’s disease
• crytobuliniaemic vasculitis
• IgA vasculitis (Henoch-Schonlein purpura)

Question 5

What is the rule of thumb in managing vasculitis?

Answer 5

Large vessel - Steroids

Small/medium vessel - immunosuppressants

Question 6

What is giant cell arteritis/ temporal arteritis?

Answer 6

systemic vasculitis of the medium and large arteries

strongly associated with PMR

Question 7

Who does GCA tend to affect?

Answer 7

patients over 60

Question 8

How does giant cell arteritis present?

Answer 8

typically with symptoms affecting the temporal arteries 
rapid onset (<1 month)

1. severe unilateral headache around temple and forhead
2. scalp tenderness when brushing hair
3. jaw claudication
4. visual disturbance - blurred or double vision, secondary to anterior ischaemic optic neuropathy
5. irreversible painless complete sight loss can occur rapidly
6. Other symptoms: lethargy, depression, low-grade fever, anorexia
7. 50% have PMR features

Question 9

What investigations would you do for GCA and what are the findings? How do you diagnose GCA

Answer 9

• clinical presentation
• Raised ESR >50 mm/hr (<30 in 10%). CRP may be elevated
• temporal artery biopsy which shows skip lesions and multinucleated giant cells

Question 10

How do you manage giant cell arteritis?

What other medications should you consider giving alongside steroids?

Answer 10

start steroids, typically a 2 year course of high dose prednisolone (60mg), reduce dose when ESR lower

usually response within 48 hrs

urgent ophthalmology review - same day if visual symptoms

• bisphosphonates
• PPI
• calcium with cholecalciferol
• Aspirin (risk of stroke)

Question 11

What is the biggest long term risk due to in GCA?

what can you give?

Answer 11

Complication of steroids

• bisphosphonates
• PPI
• calcium with cholecalciferol
• Aspirin (risk of stroke)

Question 12

What should you consider if GCA like symptoms in someone under 55?

Answer 12

Takayasu’s arteritis

Question 13

What is Takayasu’s Arteritis?

what is a key sign?

which demographic is it common in?

How does it present?

What investigation would you do?

Management?

Answer 13

large vessel vasculitis which causes aneurysms or occlusion of the aorta, can also affect pulmonary arteries

key sign is an absent limb pulse

females and asian people - rare outside japan

Presentation

• Age 40+
• non specific systemic symptoms of vasculitis e.g malaise, headache
• unequal BP in upper limbs
• carotid bruits
• intermittent claudication
• aortic regurgitation
• syncope

investigation - CT or MRI angiography

Management: steroids