Giant Cell Arteritis
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.
- Age >50
- New onset throbbing headache – temporal or occipital region, that does not respond to
- Scalp tenderness
- 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
- 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.
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
- L – Late onset,
>50 years of age
- 3 – need 3/5 of
criteria to make a diagnosis 
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.
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
- 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.