Giant cell arteritis

Last reviewed: 17 Apr 2022
Last updated: 13 Dec 2021

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
Full details

Other diagnostic factors

  • systemic symptoms
  • neurological symptoms
  • bruit on auscultation
  • asymmetric blood pressure
  • shoulder tenderness
  • limited active range of movement of shoulders and hips
Full details

Risk factors

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

Diagnostic investigations

1st investigations to order

  • CRP
  • ESR
  • FBC
  • vascular ultrasonography
  • temporal artery biopsy
  • liver function tests
  • renal function tests
Full details

Investigations to consider

  • FDG-PET scan of head to mid-thigh
  • high-resolution MRI of cranial arteries
Full details

Treatment algorithm

INITIAL

suspected GCA

ONGOING

confirmed GCA

Contributors

Expert advisers

Chetan Mukhtyar, MBBS, MSc, MD, FRCP, FRCP Edin

Consultant Rheumatologist and Lead Vasculitis Physician

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 Polymyalgia Rheumatica & Giant Cell Arteritis UK (PMRGCA UK). 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

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.

Editors

Emma Quigley,

Section Editor, BMJ Best Practice

Disclosures

EQ declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

  • Differentials

    • Polymyalgia rheumatica (PMR)
    • Solid organ cancers and haematological malignancies
    • Takayasu's arteritis
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  • Guidelines

    • 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 Guidelines
  • Patient leaflets

    Giant cell arteritis

    More Patient leaflets
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