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Giant Cell Arteritis/Temporal Arteritis

Giant Cell Arteritis (GCA) is a systemic large-vessel vasculitis, typically affecting the temporal arteries (at temple region). It usually affects caucasian women > 50 years, and is very strongly associated with Polymyalgia Rheumatica.


Presentation

  • Temporal headache - severe and unilateral

  • Scalp tenderness e.g. when brushing/combing hair

  • Jaw claudication - pain/fatigue on chewing/prolonged speaking due to ischaemic supply to masseters

  • Vision loss, which is irreversible if not treated immediately

    • It's most commonly due to arteritis anterior ischaemic optic neuropathy (AAION), which is inflammation and subsequent ischaemia of the optic nerve.

    • It's less commonly due to central retinal artery occlusion (CRAO), which is ischaemia of the retina.

“Superficial temporal artery” © Opzwartbeek CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Complications

The main complication is Permanent vision loss. This is avoided by giving high-dose steroids immediately once suspected to prevent further progression of the vision loss.


Other complications include:

  • Stroke

  • Relapse

  • Aortic complications, including Aortic aneurysm and dissection


Investigations

  • Bloods - ESR, FBC

  • Temporal artery biopsy - This is needed for a definitive diagnosis. It will show multi-nucleated giant cells.


Management

  • Urgent referral to opthalmology

  • Start immediately on 40-60mg Prednisolone PO

    • Should be a major improvement after 45 mins

  • After good response, start on Reducing Regime

  • If symptoms recur while on reducing regime, you may need to increase dose or stay on dose longer before reducing again


N.B. Give Methylprednisolone 500-1000mg if vision loss on presentation.


Alongside steroids, the patients should be co-prescribed:

  • Bisphosphonates for bone protection

  • PPI for gastro protection

  • Low-dose Aspirin for risk of vision loss and stroke




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