Giant Cell Arteritis (temporal arteritis)

Question 1

What is giant cell arteritis?

Answer 1

Chronic vasculitis of large + medium arteries

Question 2

Common demographic of giant cell arteritis

Answer 2

Older white patients
>50
Women
Associated with polymyalgia rheumatica

Question 3

Risk factors of giant cell arteritis

Answer 3

Increasing age
Female
Association to polymyalgia rheumatica
Genetic predisposition - HLA-DR4

Question 4

Presentation of giant cell arteritis

Answer 4

• unilateral headache (typically around temple + forehead)
• tongue or jaw claudication
• amaurosis fugax
• scalp tenderness
• blurred or double vision

Question 5

Associated features of giant cell arteritis

Answer 5

• symptoms of polymyalgia rheumatica (shoulder + pelvic girdle pain + stiffness)
• weight loss
• fatigue
• muscle tenderness
• carpal tunnel syndrome
• peripheral oedema

Question 6

Diagnosis of giant cell arteritis

Answer 6

Presence of 2 or more of following in patients >50:
- raised ESR, CRP or plasma viscosity
- new onset of localised headache
- tenderness or decreased pulsation of temporal artery
- new visual symptoms
- biopsy revealing necrotising arteritis

Question 7

What is the most serious complication of giant cell arteritis?

Answer 7

Permanent visual loss

Question 8

Management of giant cell arteritis

Answer 8

• prednisolone OD if no jaw claudication or visual symptoms
• methylprednisolone OD if visual symptoms
• 75mg aspirin
• PPI for gastroprotection whilst on steroids
• bisphosphnoates, calcium + vitamin B for bone protection whilst on steroids

Question 9

What is also needed to be taken when taking steroids and why?

Answer 9

• PPI: gastroprotection
• bisphosphonates, calcium + vitamin D: bone protection