SHM's Clinical Quick Talks-Giant Cell Arteritis (GCA)

Pdf Summary
Giant Cell Arteritis (GCA), formerly known as temporal arteritis, is a type of large vessel vasculitis that primarily affects the aorta and other major blood vessels. It is the most common type of vasculitis in adults, with a higher incidence in individuals of White race. GCA is rarely seen in individuals younger than 50 years old, with the average age of onset being 76.7 years. It is more prevalent in females, with a female to male ratio of 2 to 3:1.<br /><br />Common symptoms of GCA include headache (60-70% of cases), which is usually temporal but can also be frontal or occipital. Other symptoms include constitutional symptoms such as fever of unknown origin, weight loss, and anorexia (50%), jaw and tongue claudication characterized by pain with chewing (50%), polymyalgia rheumatica (40-50%), and vision symptoms (15%) such as partial or complete loss of vision, blurry vision, diplopia, or amaurosis fugax. Arm claudication is less common (4-15%).<br /><br />Diagnosing GCA involves conducting various laboratory tests to check for inflammation markers, such as a complete blood count, comprehensive metabolic panel, and measurement of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. The gold standard for diagnosis is a temporal artery biopsy, which should be performed within 2 weeks of starting steroid treatment. Cranial Doppler ultrasound can also be used, although temporal artery biopsy is recommended.<br /><br />Treatment for GCA involves a long taper of prednisone along with a glucocorticoid sparing agent, such as tocilizumab. The initial dose of prednisone is based on the presence or absence of visual loss at presentation. Potential side effects of treatment include increased risk of infection, high blood sugar, high blood pressure, thinning of the skin, easy bruising, tendon rupture, avascular necrosis, anxiety, insomnia, weight gain, and osteoporosis.<br /><br />It is important to be aware of the clinical presentation of GCA, which includes new onset headache in individuals over 50 years old, along with other symptoms such as constitutional symptoms, jaw claudication, and vision changes. Suspected cases should have inflammatory markers checked, and high dose steroids should be initiated. If vision is threatened, intravenous methylprednisolone should be started. Referral for temporal artery biopsy and consultation with rheumatology and ophthalmology are recommended. Aspirin may be beneficial in reducing vision loss and strokes, and screening for glucocorticoid-induced osteoporosis is also advised.
Asset Subtitle
Michelle Nguyen, Sonam Kiwalkar
Keywords
Giant Cell Arteritis
Temporal Arteritis
Large Vessel Vasculitis
Aorta
Major Blood Vessels
Headache
Fever of Unknown Origin
Weight Loss
Jaw Claudication
Vision Symptoms