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Updated: Dec 28 2021

Giant Cell Arteritis

  • Snapshot
    • A 65-year-old woman presents to the emergency department due to a severe headache and visual impairment in the right eye. Her symptoms are associated with pain with chewing and proximal muscle morning stiffness. On physical exam, she has decreased visual acuity of the right eye, scalp tenderness on the right, and an absent pulse in the right temporal area. Laboratory testing is significant for an elevated erythrocyte sedimentation rate. She is admitted and immediately started on systemic glucocorticoids.
  • Introduction
    • Clinical definition
      • a chronic large- and medium-sized vessel vasculitis that typically involves the
        • temporal artery
        • cranial arteries
  • Epidemiology
    • Incidence
      • most common systemic vasculitis affecting patients ≥ 50 years of age
    • Demographic
      • woman > men
  • Etiology
    • Presumed to be autoimmune
    • Pathogenesis
      • T-cells and monocytes are recruited to the vessel wall and result in an inflammatory response
    • Associated conditions
      • polymyalgia rheumatica
  • Presentation
    • Symptoms
      • temporal headache
      • jaw claudication
      • amaurosis fugax
      • symptoms of polymyalgia rheumatica (PMR)
        • morning stiffness
    • Physical exam
      • scalp tenderness
      • palpation of the temporal area may demonstrate
        • absent pulse
        • knot-like swelling
      • vision loss
      • findings of PMR
        • distal extremity swelling
  • Imaging
    • Color-coded duplex ultrasound
      • indication
        • to assess the temporal arteries and extracranial vessels
  • Studies
    • Labs
      • ↑ erythematous sedimentation rate
      • ↑ C-reactive protein
    • Temporal artery biopsy
      • confirms the diagnosis
  • Differential
    • Migraine
      • distinguishing factors
        • may be accompanied by an aura, photophobia, and phonophobia
    • Takayasu arteritis
      • distinguishing factors
        • typically affects young and Asian women
        • also treated with steroids
  • Treatment
    • Management approach
      • high-dose systemic glucocorticoids should be promptly administered even before the diagnosis is established
      • temporal artery biopsy confirms the diagnosis
    • Medical
      • corticosteroids
        • indication
          • standard initial treatment for patients suspected of having temporal arteritis
  • Complications
    • Blindness
  • Prognosis
    • Relapses can occur in 20-50% of patients
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