Giant cell arteritis (GCA) is a common form of vasculitis in people aged 50 years or older. The extracranial branches of the carotid artery are usually affected.
Irreversible blindness is the most common serious consequence. Aortic aneurysms and large vessel stenoses may occur as a long-term complication.
Temporal artery ultrasonography and/or biopsy is the definitive test to establish diagnosis.
Patients with jaw claudication, diplopia, and an abnormal temporal artery on examination are more likely to have a vascular ultrasonography and/or biopsy that is positive for GCA. GCA is unlikely if levels of inflammatory markers are normal.
Prednisolone is a highly effective therapy. Treatment should not be delayed while awaiting confirmatory test results.
Tocilizumab is a novel biological with therapeutic and glucocorticoid-sparing benefit in the treatment of GCA.
Giant cell arteritis (GCA) is a granulomatous vasculitis of large and medium-sized arteries. It primarily affects branches of the external carotid artery, and it is the most common form of systemic vasculitis in adults. GCA typically occurs in people aged 50 years or older and is more common in women. The most common serious consequence of GCA is irreversible loss of vision due to optic nerve ischaemia. GCA is sometimes also referred to as temporal arteritis, cranial arteritis, or granulomatous arteritis.
History and exam
Key diagnostic factors
- presence of risk factors
- 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
- age >50 years
- female sex
- genetic factors
- environmental factors
1st investigations to order
- vascular ultrasonography
- temporal artery biopsy
- liver function tests
- renal function tests
Investigations to consider
- FDG-PET scan of head to mid-thigh
- high-resolution MRI of cranial arteries
Chetan Mukhtyar, MBBS, MSc, MD, FRCP, FRCP Edin
Consultant Rheumatologist and Lead Vasculitis Physician
Norfolk and Norwich University Hospital
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.
CM is a trustee of Polymyalgia Rheumatica & Giant Cell Arteritis UK (PMRGCA UK). CM is an author of references cited in this topic.
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
Gary Reynolds, BSc, MRCP, PhD
Wellcome Trust Clinical Career Development Fellow
Translational and Clinical Research Institute
Honorary Consultant Rheumatologist
GR is a co-author on the British Society of Rheumatology guidelines on the management of giant cell arteritis.
GR declares that he has no competing interests.
Section Editor, BMJ Best Practice
EQ declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
RW declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
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- 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
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