Review Question - QID 107656

The elderly patient presents with a clinical history concerning for giant cell arteritis (GCA), also known as temporal arteritis. Prompt treatment with corticosteroids can prevent vision loss, a complication of GCA.

GCA is classified as a large-vessel vasculitis, in contrast to medium- and small-vessel vasculitides. It can involve the temporal artery, the aorta, and other large upper extremity arteries. The most common (80%) cause of vision loss in patients with GCA is anterior ischemic optic neuropathy (due to occlusion of the posterior ciliary artery). Treatment with corticosteroids can potentially prevent this complication. Typically, patients are initiated on prednisone 40-60mg daily; the effect can be prompt and dramatic in some cases.

Caylor et al. review the diagnosis and management of polymyalgia rheumatica/GCA. These two related syndromes have overlap, and can occur together. Unfortunately, GCA can present in varied ways, including threatened vision, upper extremity claudication, or even fatigue alone. Patients are often kept on oral corticosteroids for some time, and for this reason the adverse effects of steroids should be prophylaxed against and monitored for.

Garcia-Martinez et al. conducted a prospective study evaluating patients with GCA for aortic involvement (either aneurysm or dilatation). Although many patients were lost to follow-up, they found that the majority of aortic involvement occurred in the thoracic aorta, and that dilatation occurred progressively over time. Over time, half of patients developed dilation to the point of being recommended for surgical repair.

Incorrect Answers:
Answer 1: Renal failure is closely associated with SLE among autoimmune conditions, not GCA.
Answer 3: Pericarditis can also be associated with SLE.
Answer 4: Pulmonary fibrosis can be associated with scleroderma and related conditions.
Answer 5: Cognitive impairment is not associated with GCA.