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 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 temporal artery biopsy that is positive for GCA. GCA is unlikely if levels of inflammatory markers are normal.
Prednisone is highly effective therapy. Treatment should not be delayed while awaiting biopsy.
Tocilizumab is a novel biologic with therapeutic and corticosteroid-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 50 years of age or older and is more common in women. Symptoms of polymyalgia rheumatica are frequently present. The most common serious consequence of GCA is irreversible loss of vision due to optic nerve ischemia. GCA is sometimes also referred to as temporal arteritis, cranial arteritis, or granulomatous arteritis.
History and exam
Key diagnostic factors
- 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
- 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
- age >50 years
- female sex
- genetic factors
- environmental factors
1st investigations to order
- temporal artery biopsy
- temporal artery ultrasound
Investigations to consider
- aortic arch angiography
- FDG-PET scan of head to mid-thigh
- ultrasound scan of the upper extremity arteries
Kenneth J. Warrington, MD
Professor of Medicine
Mayo Clinic College of Medicine
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.
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.
Gene Hunder, MD
Professor of Rheumatology
GH declares that he has no competing interests.
Kuntal Chakravarty, FRCP (London), FRCP (Glasgow), FRCP (Ireland), FACP (USA), FACR (USA)
BHRT University Hospital
KC declares that he has no competing interests.
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