giant cell artiritis Flashcards
also called
temporal artiritis
PMR link
50% have features of pmr
symptoms
depend on which arteries are effected
- frequent severe headaches
- pain and tenderness at temples and scalp
- jaw claudication - pain while eating or talking
- vision problems
- flu-like, weight loss, depression, tiredness
vision problems pathophysiology
- anterior ischeamic optic neuropathy
- occlusion of posterior ciliary artery
- causing ischemea of nerve head
how are eye visions assessed
fundoscopy
- swollen pale disc and blurred margins
investigation first line
ESR
investigations
- ESR / CRP - first line
- temporal artery biopsy
- FBC - inc platelets
normochromic normocytic anaemia - bloods to assess complications of steroids eg lft, HbA1c, VitD
- ultrasound - halo sign
OFTEN PATCHY SKIP LESIONS SO TAKE A BIG SAMPLE
whats shown on a temporal artery biopsy
skip lesions and granulomatous inflammation with multinucleated giant cell
which arterial layer
tunica media
pathology - aetiology
cell-mediated immunity involving TH1 and interferon gamma in tunica media
treatment if visual loss present
STAT IV methylprednisolone
what is seen on ultrasound
halo sign
treatment if visual problems are not present
oral prednisolone 60mg
1mg/kg for 4 weeks - gradually tapered over 6 months to a year
epidemiology
women
age >60
northern european - scandanavians
caucasion
why would a rash / shingles form
long term immunosuppresants (prednisolone)
what other medications apart from immunosuppressants (prednisolone) may need to be given as well
low dose aspirin - prevent stroke
PPI - because prednisolone causes stomach ulcers
bisphosphonate therapy - because prednisolone causes osteoporosis
immunosuppressant - allow steroid medication to be reduced
name the different carotid branches which can be affected and the symptoms specific to this
- temporal branch=scalp tenderness
- ophthalmic branch=vision (blurring, Diplopoda, photopsia, loss)
- facial branch=jaw and tongue claudication
signs which aren’t present in GCA which rule it out - negative features
Features of a serious headache but not of GCA
- Vomiting ( raised intercranial pressure)
- Any acute localising clinical signs ( acute intracerebral bleeding, encephalitis, meningitis)
- Fever (infection)
black curtain
amaurosis fugax
- typically seen in TIA
- temporary complication of GCA
