Giant Cell Arteritis

Question 1

What is giant cell arteritis?

Answer 1

Ocular emergency

Inflammation of small/medium sized arteries - mostly head/neck (excluding intracranial

Question 2

Complications of GCA

Answer 2

Can go blind if treatment delayed

Question 3

What is the top differential in a patient over 60 with sudden vision loss?

Answer 3

GCA

Question 4

Which patients are typically affected by GCA?

Answer 4

Age >60

Commoner >80

Northern European

Question 5

Clinical features of GCA

Answer 5

Headache

Scalp tenderness

Weight loss

Malaise

Polymyalgia

Vision loss may be intermittent at first (differential of retinal TIA)

Usually sudden, painless, profound loss of vision of one eye

Other eye usually goes with 48hrs if untreated

Question 6

Exam findings in GCA

Answer 6

Obvious RAPD and pale swollen disc

Could be pale, ischaemic retina

Question 7

Management of GCA

Answer 7

Treat first then investigate

Oral prednisolone 60-80mg or IV methylprednisolone 0.5-1.0g

Prednisolone tapered slowly over 12-18 months (too fast = recurs)

Co-prescribe bone and gastric protection

CXR to exclude Ca/TB

Question 8

Investigations in GCA

Answer 8

↑↑CRP and ESR

Platelets often also high

Temporal artery biopsy (may take days)

US doppler of temporal arteries

Question 9

Side effects of systemic prednisolone

Answer 9

Osteoporosis

Diabetes

Hypertension

Infection