Giant cell arteritis

This man's head is on fire. Underneath the fire, however, he has temporal arteritis. This is very serious, since it could affect his sight.

Definition

Giant Cell arteritis, or Temporal arteritis, is an inflammation of the giant cells in the wall of the temporal artery (in the temples).

Epidemiology

Pretty rare, but also VERY important. It affects the over 50s, most commonly in 75+, most often in women.

Pathophysiology

Giant cell arteritis is a type of vasculitis, an inflammation of blood vessels. Linked to other autoimmune conditions such as lupus and rheumatoid arthritis. It is serious because the inflammation of the arteries can occlude blood supply, and it can affect the aorta, and cause blindness. It is a medical emergency!

Clinical Features

Commonly presents with headache, coming on over a few days.

• There may be some tenderness on the side of the head.
• Accompanied with fever.
• There may also be blurred or lost vision.

Investigations

Examination

1. Look for enlarged of temporal arteries.
2. Tenderness on side of head.
3. Reduced pulses, or fundal ischaemia are pretty key too!

Blood tests

Look for raised inflammation markers:

• ESR
• CRP
• Platelet Count

Biopsy

This is the best test, taking a small chunk out of the temporal artery, and testing it.

Management

Give 'em steroids! About a bucket full IV. Basically start them off with IV prednisolone to prevent visual loss, then oral prenislone 40-60mg bd for a few weeks, slowly tapering off over the next year.

Prognosis

Most people make a full recovery, but a full year of steroid may have accompanying steroid side effects