Musc Dis- Giant cell arteritis

Question 1

what is giant cell arteritis (2)

Answer 1

most common form of systemic vasculitis in adults

It is of unknown aetiology and occurs in older patients.

Question 2

GCA pathogenisis

Answer 2

marked by transmural inflammation of the intima, media, and adventitia of affected arteries, as well as patchy infiltration by lymphocytes, macrophages, and multinucleated giant cells.

Vessel wall thickening can result in arterial luminal narrowing, resulting in subsequent distal ischemia.

Question 3

presentation / symptoms

Answer 3

visual disturbances- Visual loss/perm impairment 20%

headache- temporal or occipital areas

jaw claudication

scalp tenderness- hair combing

Question 4

signs (2)

Answer 4

Swollen optic disc

The temporal artery thickened, prominent and tender to touch.

Question 5

Constitutional symptoms (3)

Answer 5

fatigue

malaise

fever

Question 6

diagnosis

Answer 6

Inflammatory markers are almost always raised.

most definitive test is a temporal artery biopsy. A positive temporal artery biopsy has 100% specificity but relatively low sensitivity (15-40%) for the diagnosis of GCA.

Typical biopsy findings include mononuclear infiltration or granulomatous inflammation, usually with multinucleated giant cells.

Question 7

treatment

Answer 7

mainstay of therapy is corticosteroids, usually prednisolone 40mg if no visual impairment and 60mg if visual symptoms.

treatment with steroids should be started as soon as the diagnosis is suspected and should not be delayed for the biopsy.

The prednisolone dose is gradually tapered over around 2 years. For the majority of patients the condition will resolve over this period.