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Giant cell arteritis

Last reviewed: 12 Oct 2024
Last updated: 05 Mar 2024

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
Full details

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
  • dental pain, tongue pain, or infarction of the tongue
Full details

Risk factors

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

Diagnostic tests

1st tests to order

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

Tests to consider

  • noninvasive vascular imaging
Full details

Emerging tests

  • FDG-PET scan of head to mid-thigh

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, GSK, 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. He has received honoraria and consulting fees from Chemocentryx. 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

Anisha B. Dua, MD, MPH

Associate Professor

Northwestern University Feinberg School of Medicine

Chicago

IL

Disclosures

ABD declares they have paid consultancies from Amgen, Abbvie, Novartis, GSK and Sanofi. ABD is on the board of directors for the Vasculitis Foundation.

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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