Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- headache
- scalp pain or tenderness
- aching and stiffness
- extremity (limb) claudication
- loss of vision
- jaw and tongue claudication
- arterial tenderness, thickening, or nodularity
- absent pulse
- abnormal fundoscopy
Other diagnostic factors
- systemic symptoms
- neurological symptoms
- bruit on auscultation
- asymmetric blood pressure
- shoulder tenderness
- limited active range of movement of shoulders and hips
- dental pain, tongue pain, or infarction of the tongue
Risk factors
- age ≥50 years
- female sex
- genetic factors
- smoking
- atherosclerosis
- environmental factors
Diagnostic investigations
1st investigations to order
- CRP
- ESR
- FBC
- vascular ultrasonography
- temporal artery biopsy
- liver function tests
- renal function tests
Investigations to consider
- fluorodeoxyglucose (FDG)-PET scan of head to mid-thigh
- high-resolution MRI of cranial arteries
Treatment algorithm
suspected GCA
confirmed GCA
Contributors
Expert advisers
Chetan Mukhtyar, MBBS, MSc, MD, FRCP
Consultant Rheumatologist and Service Director for Rheumatology
Norfolk and Norwich University Hospital
Norwich
UK
Biography
CM is a co-author on the British Society of Rheumatology guidelines on the management of giant cell arteritis and the EULAR recommendations for the management of large vessel vasculitis.
Disclosures
CM is a trustee of the British Society for Rheumatology. CM is an author of references cited in this topic.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Kenneth J. Warrington, MD
Professor of Medicine
Mayo Clinic College of Medicine
Rochester
MN
Disclosures
KJW’s employer receives payments from Eli Lilly and GlaxoSmithKline for his role as investigator in giant cell arteritis clinical trials. KJW has conducted consulting work for Sanofi. KJW is an author of a number of references cited in this topic.
Peer reviewers
Gary Reynolds, BSc, MRCP, PhD
Wellcome Trust Clinical Career Development Fellow
Translational and Clinical Research Institute
Newcastle University
Honorary Consultant Rheumatologist
Freeman Hospital
Newcastle
UK
Biography
GR is a co-author on the British Society of Rheumatology guidelines on the management of giant cell arteritis.
Disclosures
GR declares that he has no competing interests.
References
Key articles
Ponte C, Grayson PC, Robson JC, et al. 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Arthritis Rheumatol. 2022 Dec;74(12):1881-9. Abstract
Hellmich B, Agueda A, Monti S, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020 Jan;79(1):19-30.Full text Abstract
Mackie SL, Dejaco C, Appenzeller S, et al. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology (Oxford). 2020 Mar 1;59(3):e1-e23.Full text Abstract
Coath FL, Bukhari M, Ducker G, et al. Quality standards for the care of people with giant cell arteritis in secondary care. Rheumatology (Oxford). 2023 Sep 1;62(9):3075-83. Abstract
Dejaco C, Ramiro S, Bond M, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update. Ann Rheum Dis. 2024 May 15;83(6):741-51.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Polymyalgia rheumatica (PMR)
- Solid organ cancers and haematological malignancies
- Takayasu's arteritis
More DifferentialsGuidelines
- British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis
- 2018 update of the EULAR recommendations for the management of large vessel vasculitis
More GuidelinesPatient information
Giant cell arteritis
More Patient information
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