Giant cell arteritis

Giant cell arteritis (=temporal arteritis) is a systemic medium and large vessel vasculitis with a predilection for the extracranial branches of the carotid arteries

Presentation may include 
  • Headache (around 70%) 
  • Jaw claudication (around 40%) 
  • Fever (around 30%) 
  • Amarosis fugax (around 25%) 

The American College of Rheumatology GCA diagnostic criteria gives >90% sensitivity and specificity if >/= 3 of the following are present:
  • age =/> 50
  • new onset localised headache
  • ESR >/= 50mm/hr
  • temporal tenderness or decreased temporal pulse
  • characteristic biopsy.]

Roughly 50% of people with giant cell arteritis also have polymyalgia rheumatica
Almost all patients are >50 years old
Women are more frequently affected than men (3:1)
There is an association with HLA-DR4 

  • ESR – usually raised 
  • Abnormal temporal arteries on examination 
  • Temporal artery biopsy
    • Mononuclear infiltrates or granulomas
    • Normal biopsy does not exclude diagnosis as there are ‘skip lesions’ 

Treatment is oral steroids (start at 1mg/kg prednisolone unless visual impairment or stroke, in which case use IV methylprednisolone) Taper slowly but continue for at least 12 months.

  • Irreversible blindness (up to 10%)
  • Aortic aneurysms 
  • Aortic regurgitation
  • Ischaemic strokes 
  • Recurrence -  up to 40% relapse within 2 years.

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