Contents
Giant cell arteritis (GCA) (previously called temporal arteritis or cranial arteritis), is a non-necrotizing granulomatous vasculitis affecting large and middle-sized arteries occurring most frequently in the seventh decade.
- M/C large vessel vasculitis
- MEDICAL EMERGENCY (due to the potential of irreversible vision loss)
Clinical features
Classic symptoms:
Patients may state that their headache has been occurring for a duration of 2 to 3 months and worsens with exposure to cold and at night when the pressure of the pillow causes pain to the artery
- Headaches
- Scalp (temporal artery) tenderness
- Painless vision loss
- Muscle stiffness and pain
Complications
- Monocular blindness (M/seroius)
- Aortic aneurysm
- Myocardial infarction
- Stroke
- Peripheral arterial disease
- Polymyalgia rheumatica
Diagnosis
American College of Rheumatology (ACR) diagnostic criteria (1990):
3 of the 5 criteria must be present to make the diagnosis
- Age ≥ 50 years at the onset of disease
- New headache
- Temporal artery abnormalities such as tenderness of the superficial artery or decreased pulsation
- ESR ≥ 50 mm/h
- Abnormal artery biopsy, including vasculitis, a predominance of mononuclear cell infiltration or granulomatous inflammation, or multinucleated giant cells.
Management
- High dose IV steroids (first line treatment)
- Low-dose aspirin
- Methotrexate
- Biologic agents (TNF blockers, abatacept, rituximab, ustekinimab, rituximab and anakinra)