Giant Cell Arthritis

Question 1

What is giant cell arthritis?

Answer 1

Most common form of systemic vasculitis in adults of unknown aetiology and usually occurring in older patients

Question 2

Histopathology of giant cell arthritis

Answer 2

Transmural inflammation of the intima, media and adventitia of affected arteries as well as patchy infiltration by lymphocytes, macrophages and multinucleated giant cells. The thickening of vessel walls can result in arterial lumen narrowing and subsequent distal ischaemia.

Question 3

Presentation of giant cell arthritis

Answer 3

Visual disturbances
Headache
Jaw claudication
Scalp tenderness
Fatigue
Malaise
Fever

Question 4

When should giant cell arthritis always be considered in the DD?

Answer 4

New-onset headache in patients over 50 years of age with elevated erythrocyte sedimentation rate (ESR), CRP or plasma viscosity

Question 5

What is the nature of the headache associated with giant cell arthritis?

Answer 5

Located in temporal or occipital areas
Focal tenderness on direct palpation
Scalp tenderness with hair combing
Thickened, prominent and tender to touch temporal artery

Question 6

Diagnosis of giant cell arthritis

Answer 6

Inflammatory markers almost always raised
Definitive test = temporal artery biopsy showing mononuclear infiltration or granulomatous inflammation usually with multinucleated giant cells.

Question 7

Treatment of giant cell arthritis

Answer 7

Corticosteroids (prednisolone 40mg if no visual impairment, 60mg if visual symptoms)
Treatment should start without delay or waiting for biopsy
Dose tapered over 2 years, most patients’ condition resolve in this period of time.