GIANT CELL ARTERITIS

SUMMARY

1. Body pain + vision complaints in the elderly (>55yrs) + ESR = PMR with GCA!

2. Multinucleated giant cells infiltrate vessels arising from the aortic arch in a patchy or segmental fashion.

3. Symptoms include temporal headache, diplopia, amaurosis fugax, scalp tenderness, and jaw claudication (very specific!).

4. Untreated, 40-50% get ischemic optic neuropathy with unilateral irreversible blindness (increased risk in the setting of thrombocytosis). Also, increased risk of aortic aneurysms.

5. The ESR is commonly very elevated, but CRP is a more sensitive marker of inflammation. Do a temporal artery biopsy if the diagnosis is suspected. Follow ESR to monitor activity.

6. Commence glucorticoids (prednisolone 60mg/day) ASAP. If vision loss develops, commence high-does IV Methylpred for 3-5 days.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].