Temporal (Giant cell) arteritis

Question 1

What is giant cell arteritis

Answer 1

Systemic vasculitis of the medium and large arteries. Typically affects temporal arteries - temporal arteritis.

Question 2

Giant cell arteritis presentation

Answer 2

Female >50yrs
Severe unilateral headache typically around temples and forehead
Jaw claudication (fatigue or discomfort of jaw muscles during chewing)
Blurred or double vision - can have rapid deterioration to irreversible sight loss
Scalp tenderness
Associated systemic symptoms: fever, muscle aches, fatigue, weight loss, loss of appetite, peripheral oedema

Question 3

Giant cell arteritis differentials

Answer 3

Cluster headache or migraine
Acute angle closure glaucoma
Ankylosing spondylitis

Question 3

Giant cell arteritis investigations

Answer 3

Raised ESR (erythrocyte sedimentation rate) - usually 50mm/hour or more
Temporal artery biopsy - multinucleated giant cells found

Question 4

Giant cell arteritis investigations

Answer 4

Raised ESR (erythrocyte sedimentation rate) - usually 50mm/hour or more
Temporal artery biopsy - multinucleated giant cells found
CRP usually raised

Question 5

Giant cell arteritis associated conditions

Answer 5

Polymyalgia rheumatica

Question 6

Giant cell arteritis management

Answer 6

Medical emergency - urgent same day assessment by an ophthalmologist if visual symptoms
Start steroids immediately to reduce the risk of sight loss - 40-60mg prednisolone per day. Should be rapid and significant response - review within 48hrs.
PPI e.g. omeprazole (20mg daily?) for gastric protection while on steroids.

Question 7

Giant cell arteritis referrals

Answer 7

Vascular surgeons - temporal artery biopsy
Rheumatology - management
Ophthalmologists if visual symptoms - urgent same day

Question 8

Giant cell arteritis long term management

Answer 8

Continue high dose steroids (40-60mg) until symptoms resolve. Slowly wean off steroids - can take years (similar to polymyalgia).
Don’t STOP mnemonic for steroids:
DON’T - don’t stop taking abruptly as risk of adrenal crisis
S - Sick day rules as decreased immunity
T - need treatment card on you
O - osteoporosis prevention with bisphosphonates, supplemental calcium and vit D.
P - PPI for gastric protection

Question 9

Giant cell arteritis complications

Answer 9

Vision loss
Stroke
Relapses common
Steroid related side effects and complications
Aortitis leading to aortic aneurism and aortic dissection
Increased risk of CVD