Summary
Definition
History and exam
Key diagnostic factors
- headache
- polymyalgia rheumatica symptoms
- older age
- extremity claudication
- jaw claudication
- sudden loss of vision
- arterial tenderness, thickening, or nodularity
- absent temporal artery pulse
- abnormal fundoscopy
Other diagnostic factors
- systemic symptoms
- neurologic symptoms
- cough, sore throat, hoarseness
- bruit on auscultation
- asymmetric blood pressure
- shoulder tenderness
- limited active range of movement of shoulders and hips
- wrist and knee swelling
- dental pain, tongue pain, or infarction of the tongue
Risk factors
- age ≥50 years
- female sex
- genetic factors
- smoking
- atherosclerosis
- environmental factors
Diagnostic tests
1st tests to order
- CRP
- erythrocyte sedimentation rate (ESR)
- CBC
- LFTs
- temporal artery biopsy
- temporal artery ultrasound
Tests to consider
- noninvasive vascular imaging
Emerging tests
- 18F-fluorodeoxyglucose (FDG)-PET scan of head to mid-thigh
Treatment algorithm
suspected giant cell arteritis
confirmed giant cell arteritis
Contributors
Expert advisers
Kenneth J. Warrington, MD
Professor of Medicine
Mayo Clinic College of Medicine
Rochester
MN
Disclosures
KJW’s employer receives payments from Eli Lilly, GSK, and Kiniksa for his role as investigator in giant cell arteritis clinical trials. KJW has conducted consulting work for Sanofi, and received compensation from Roche/Genentech for lecturing. He has received honoraria and consulting fees from Chemocentryx. KJW is an author of a number of references cited in this topic.
Acknowledgements
Dr Kenneth J. Warrington wishes to gratefully acknowledge Dr Eric L. Matteson, a previous contributor to this topic.
Disclosures
ELM’s employer has received payments from Bristol Myers Squibb and GlaxoSmithKline for his role as investigator in giant cell arteritis clinical trials; from Novartis for his role in polymyalgia rheumatica clinical trials; and from GlaxoSmithKline for his role as an advisory consultant. ELM is an author and editor for Up To Date and Paradigm, as well as an author of a number of references cited in this topic.
Peer reviewers
Anisha B. Dua, MD, MPH
Associate Professor
Northwestern University Feinberg School of Medicine
Chicago
IL
Disclosures
ABD declares they have paid consultancies from Amgen, Abbvie, Novartis, GSK and Sanofi. ABD is on the board of directors for the Vasculitis Foundation.
Kuntal Chakravarty, FRCP (London), FRCP (Glasgow), FRCP (Ireland), FACP (USA), FACR (USA)
Consultant Rheumatologist
BHRT University Hospital
Queen’s Hospital
Romford
UK
Disclosures
KC 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
Maz M, Chung SA, Abril A, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis. Arthritis Rheumatol. 2021 Aug;73(8):1349-65.Full text 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 hematologic malignancies
- Takayasu arteritis (TA)
More DifferentialsGuidelines
- EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update
- 2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis
More GuidelinesVideos
Venepuncture and phlebotomy: animated demonstration
More videosPatient information
Giant cell arteritis
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer