Giant Cell Arteritis

Exam Cram

• Giant Cell Arteritis (also called temporal arteritis) is a inflammatory vasculitis of large arteries, highly associated with Polymyalgia Rheumatica and anterior ischaemic optic neuropathy

• Presentations: temporal headaches, jaw claudication, temporal artery tenderness +- unilateral blindness

• Investigation: raised CRP / ESR, biopsy (skip lesions)

• Management: high dose prednisolone

Outline

Background 

• Strong link with Polymyalgia Rheumatica 

• Key complication: anterior ischaemic optic neuropathy 

Assessment

History:

• > 60yrs

• Vague decline over weeks / months with temporal headaches, jaw claudication

• Associated with shoulder and hip myalgia 

Examination:

• Morning stiffness in hips & shoulders

• Potentially unilateral blindness

Investigations Sensitivity Specificity

• Raised ESR c.90% c.50%

• Temporal biopsy c.50% c.99%

Diagnosis

Diagnostic criteria (1990) - American College of Rheumatology:

3 or more criteria: 90% sensitivity and specificity

• 1. Age > 50 years

• 2. New onset headache

• 3. Temporal artery tenderness abnormality

• 4. ESR > 50

• 5. Arterial biopsy: granulomatous inflammation with multinucleated giant cells or mononuclear cell infiltrates

In summary, diagnosis can be made clinically and steroids should be started if there would be long delays to arterial biopsy. 

Management

1. High dose steroids, e.g. 60mg prednisolone daily to prevent blindness

   • For steroid side effects: PPI, vitamin d/ calcium DXA scan, PJP prophylaxis

2. Temporal biopsy as able 

3. Wean steroids and start steroid sparing agents

Med Reg Notes

Temporal artery biopsy can be negative due to skip lesions and steroids shouldn't be delayed due to the risk of blindness. 

References

1. Giant cell arteritis · RheumTutor (2018) RheumTutor. Available at: https://www.rheumtutor.com/diseases/giant-cell-arteritis/ (Accessed: 30 September 2024).

2. Hunder et al.  The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis.  Arthritis Rheum 1990;33(8):1122-8. 

Page written in 2024.