Temporal Arteritis

Question 1

What is Temporal Arteritis/Giant Cell Arteritis (GCA)?

Answer 1

Systemic, immune mediated vasculitis affecting med/large arteries

Question 2

What are the risk factors for CGA?

Answer 2

2.2/10,000 pt years in UK
Female preponderance (3:1)
60-80yrs
Polymyalgia rheumatic (PMR)

Question 3

How does CGA present?

Answer 3

Temporal headache
Myalgia
Malaise
Fever
Transient visual sx
Unexplained facial pain

Question 4

What are the features of the temporal headache of CGA?

Answer 4

Recent onset
Temporal/occipital region
Severe
Worse at night

Question 5

What sx are highly predictive of CGA?

Answer 5

Jaw claudication
Diplopia
Abnormality on palpation of temporal aa (absent pulse, beaded, tender, enlarged)

Question 6

What investigations are appropriate in suspected CGA?

Answer 6

ESR (>50mm/hr)
Temporal arterial biopsy
Colod duplex ultrasongraphy
Bloods - FBC (anaemia) LFTs (ALP elevated)

Question 7

How is CGA managed?

Answer 7

High dose corticosteroids
-40mg Pred daily (60 if claudication sx)
-dose can be reduced after sx resolve
Low dose aspirin (75mg)

Question 8

What complications arise from untreated CGA?

Answer 8

Loss of vision (20%)
Aneurysms/dissections of aorta
CNS disease (seizures, CVA, brain ischaemia)