Giant Cell/Temporal Arteritis (1*)

Question 1

What is it?

What is it strongly associated with?

Who does it usually affect?

Answer 1

➊ Systemic vasculitis of the medium and large arteries - Typically affects the Temporal arteries

➋ Polymyalgia Rheumatica

➌ Caucasian women > 50 yrs

Question 2

How does it present?

Answer 2

● Temporal headache - severe and unilateral
● Scalp tenderness e.g. when brushing/combing hair
● Jaw claudication - pain/fatigue on chewing/prolonged speaking due to ischaemic supply to masseters
● Vision loss, which is irreversible if not treated immediately
▸ Most commonly due to arteritis anterior ischaemic optic neuropathy (AAION), which is ischaemia of the optic nerve
▸ Less commonly due to central retinal artery occlusion (CRAO), which is ischaemia of the retina

Question 3

What is its main complication?
→ How is this avoided?

What are the other complications?

Answer 3

➊ Permanent vision loss
→ High-dose steroids immediately once suspected to prevent further progression of vision loss

➋ • Stroke
• Relapse
• Aortic complications, including Aortic aneurysm and dissection

Question 4

Investigations:
Which bloods should be done?

What is used to definitively diagnose GCA?
→ What will be found?

Answer 4

➊ ESR, FBC

➋ Temporal artery biopsy
→ Multinucleated giant cells

Question 5

How is it managed?

What should all these pts be given alongside the steroids?

Answer 5

➊ * Urgent referral to opthalmology
* Start immediately on 40-60mg Prednisolone PO
‣ Should be a major improvement after 45 mins
* After good response, start on Reducing Regime
* If symptoms recur while on reducing regime, you may need to increase dose or stay on dose longer before reducing again

N.B. Give Methylprednisolone 500-1000mg if vision loss on presentation

➋ * Bisphosphonates for bone protection
* PPI for gastro protection
* Low-dose Aspirin for risk of vision loss and stroke

N.B. Prednisolone has a much higher glucocorticoid (anti-inflammatory) affect than Hydrocortisione, therefore making it a better drug for long-term disease suppresion. Also, Hydrocortisone has a higher relative mineralocorticoid (fluid retention) affect, therefore putting pts at risk if used as a long-term agent.