Introduction

Giant Cell Arteritis (GCA) aka Temporal Arteritis
Arteritis is the inflammation of the walls of the arteries. In GCA, inflamed superficial temporal or occipital arteries cause pain. Touching the skin over these vessels (e.g. when combing hair) will cause pain. The vessels may become hardened, and arterial pulsation is lost. The scalp around the arteries becomes thickened and red. It is possible that patches of gangrene occur.
It is strongly associated with Polymyalgia rheumatica (PMR).

Clinical features

  • Rare under 50
  • Generalised headaches
  • Scalp tenderness
  • Claudication of the jaw
  • Painless temporary or permanent visual loss – if more than one of the occipital or temporal arteries is affected.
  • Generalised malaise
  • Fever
  • Tiredness

Investigations

Bloods:

  • ESR
  • Normocytic / normochromic anaemia

LFT’s

  • Low albumin
  • ↑ALP
  • ↑y-GT

Temporal arterial biopsy

  • This is the definitive diagnostic test. You need to take the sample before or within 7 days of starting steroids (if these are given)
  • Histological features include:
    • Intimal hypertrophy
    • Inflammation of the intima
    • Degredation of the internal elastic lamina
    • Giant cells, lymphocytes and plasma cells in the internal elastic lamina

Treatment

Corticosteroids – 60-100mg prednisolone/day, in divided doses.– this can dramatically reduce symptoms within 24 hours. Treatment with corticosteroids once the diagnosis is made is compulsory! – it greatly reduces the risk of visual loss. It is best to start with a higher dose and gradually reduce it.

  • The disease is likely to settle after 12-36 months of treatment in 75% of cases. In the remaining 25%, low dose corticosteroids may be needed for years.
  • Calcium and vit D supplements should be given to avoid osteoporosis whilst on steroids.
  • Consider PPI for gastric protection if patient is at increased risk of GI bleeding or dyspepsia

NSAID’s should not be used.

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