Last reviewed: February 2019
Last updated: December  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • headache
  • polymyalgia rheumatica symptoms
  • extremity claudication
  • other cranial artery abnormalities
  • loss of vision
  • jaw claudication
  • superficial temporal artery tenderness, thickening, or nodularity
  • absent temporal artery pulse
  • abnormal fundoscopy

Other diagnostic factors

  • systemic symptoms
  • neurological 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

Risk factors

  • age >50 years
  • female sex
  • genetic factors
  • smoking
  • atherosclerosis
  • environmental factors

Diagnostic investigations

1st investigations to order

  • ESR
  • CRP
  • FBC
  • LFTs
  • temporal artery biopsy
  • temporal artery ultrasound
Full details

Investigations to consider

  • aortic arch angiography
Full details

Emerging tests

  • FDG-PET scan of head to mid-thigh
  • ultrasound scan of the upper extremity arteries
Full details

Treatment algorithm

INITIAL
ONGOING

Contributors

Authors VIEW ALL

Kenneth J. Warrington

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.

Dr Kenneth J. Warrington wishes to gratefully acknowledge Dr Eric L. Matteson, a previous contributor to this topic. ELM’s employer has received payments from Bristol Meyers 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 VIEW ALL

Professor of Rheumatology

Mayo Clinic

Rochester

MN

Disclosures

GH declares that he has no competing interests.

Consultant Rheumatologist

BHRT University Hospital

Queen’s Hospital

Romford

UK

Disclosures

KC declares that he has no competing interests.

Use of this content is subject to our disclaimer