Giant cell arteritis

Last reviewed: 1 Sep 2022
Last updated: 24 Aug 2021

Summary

Definition

History and exam

Key diagnostic 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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

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

Diagnostic investigations

1st investigations to order

  • ESR
  • CRP
  • CBC
  • LFTs
  • temporal artery biopsy
  • temporal artery ultrasound
More 1st investigations to order

Investigations to consider

  • aortic arch angiography
More investigations to consider

Emerging tests

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

Treatment algorithm

INITIAL

suspected GCA

ONGOING

confirmed GCA

Contributors

Authors

Kenneth J. Warrington, MD
Kenneth J. Warrington

Professor of Medicine

Mayo Clinic College of Medicine

Rochester

MN

Disclosures

KJW’s employer receives payments from Eli Lilly 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. 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 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

Gene Hunder, MD

Professor of Rheumatology

Mayo Clinic

Rochester

MN

Disclosures

GH declares that he has no competing interests.

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.

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    • 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis
    • British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis
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