Vasculitis: Giant Cell Arteritis Flashcards
GO TO REVISION TABLES TO FIND COMPREHENSIVE SUMMARY OF ALL VASCULITIS DISEASES
Definition
Inflammation of the vascular wall due to molecular mimicry where the immune system attacks the vascular endothelial cells
Most commonly affecting branches of the carotid artery
- Superficial temporal artery = headache + scalp tenderness
- Mandibular artery = Jaw claudication
- Ophthalmic artery = Visual loss (retinal ischaemia)
Epidemiology
Age = + 50
Female
Caucasians
Risk factors
Polymyalgia rheumatica (PMR)
Family history
Pathophysiology
Granulomatous inflammation along the vessel wall occurs segmentally = intimal thickening and a narrow vascular lumen.
- Aetiology unknown
Signs
Superficial artery tenderness
Absent temporal artery pulse
Reduced visual acuity
Pallor of the optic disc
Symptoms
Unilateral persistent headache
Blurred vision or amaurosis fugax
Scalp pain: classically described as pain when combing hair
Jaw claudication
Symptoms of PMR: shoulder + hip pain
Malaise
Fever
Diagnosis
FIRST LINE = ESR + CRP
GOLD STANDARD = Temporal artery biopsy
- A positive biopsy = presence of granulomas in the internal elastic lamina of the blood vessel
- Intimal thickening and a narrowed vascular lumen
- Skip lesions present = take big chunk
Fundoscopy = pallor + oedema of optic disc
Treatment
FIRST LINE = PREDNISOLONE 40-60mg
- IV methylprednisolone required for visual symptoms
Oral Aspirin 75mg - protect against ischaemic cranial complications
Complications
Sudden painless visual loss in one eye (optic neuropathy)
Aortic aneurysms
Glucocorticoid toxicity = gastritis, osteoporosis, diabetes, HTN
- give bisphosphonates + PPI as protection
DDx
Takayasu Arteritis
- Under 40 year olds
- Asian
- Women
Affects the arteries that branch off the aortic arch = serve the upper extremities
- weak non-existent pulse
- visual and neurological symptoms
