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Giant Cell Arteritis

From Mediwikis


Inflammatory granulomatous arteritis of large cerebral arteries in patients aged over 55.

Uncommon but most common form of vasculitis.

Incidence : 2.2cases/10000 person years

Affects medium sized vessels

Associated with and is on a spectrum with Polymyalgia Rheumatica (PMR)

PMR presents with symmetrical muscle pain and stiffness in the shoulder and pelvic girdle.

50 % of patients with PMR have GCA.

Rare under the age of 60.

Symptoms

  • Age >50
  • New onset throbbing headache – temporal or occipital region, that does not respond to

pain killers.

  • Scalp tenderness
  • Fever
  • Jaw claudication –Pain when chewing due to ischaemia of the masseter muscles.
  • Fundoscopy – pale and inflamed optic disc with haemmorhages but take 48 hours to develop. May be

normal.

  • Visual disturbances – changes in visual acuity and fields.
  • Later stage : Blindness in one eye due to inflammation of the posterior cilliary artery and opthalmic artery involvement.

Diagnosis

Good mnemonic to remember the diagnosis

  • T – Temporal artery tenderness
  • E – ESR elevated

>= 50 mm/h

  • M – Multinucleated

giant cells on biopsy

  • P – Pain, new

onset

  • L – Late onset,

>50 years of age

  • 3 – need 3/5 of

criteria to make a diagnosis [1]

Investigations

Laboratory : Elevated ESR

Temporal arterial biopsy (sometimes guided by ultrasound) – if GCA present, internal elastic lamina is broken down with inflammatory cells influx like multinucleated giant cells – necrotizing vasculitis. Don't be put off by a negative biopsy because GCA has skip lesions so it cannot be excluded.

Management

Aim is to prevent blindness!

  • Corticosteroids are main stay of treatment.
  • Urgent treatment needs to be given before investigations are carried out due to risk of

blindness.

  • Commence prednisolone 40–60 mg daily
  • Review patient in a few days time.
  • Usually there is a dramatic response to treatment as symptoms can resolve in as early as 2 days!
  • Steroid dose is then progressively reduced to a dose of 10–15 mg by 8 weeks.
  • Treatment usually is stopped in 1–2 years.
  • British journal of hospital medicine (London, England: 2005) (Impact Factor:0.38).12/2012; 73(12):714. DOI: 10.12968/hmed.2012.73.12.714a Source: PubMed Colledge, Nicki R., Walker, Brian R., Ralston, Stuart.,Davidson, Stanley,,. Davidson's principles and practice of medicine. 2010