Giant Cell Arteritis Def. , clinical picture , investigation and treatment

Giant Cell Arteritis  GCA   ( Temporal Arteritis )

What is Giant Cell Arteritis ? 


• It is a large vessel vasculitis, predominantely affecting the cranial vessels especially branches of temporal and ophthalmic arteries.
• There is inflammatory infiltrate of lymphocytes, plasma cells and giant macrophages.

How to diagnose Giant Cell Arteritis ?

Clinical picture

giant cell arteritis

It usually affects individuals with mean age around 70 years with female: male ratio 4 : 1.

 -  Headache (usually the first symptom)
    • Unilateral (temporal or occipital).
    • Temporal or occipital arteries are thick and tender.


 - Visual disturbance
The optic nerve is supplied by the posterior ciliary artery, vasculitis of which leads to occlusion with acute anterior ischaemic optic neuropathy,
leading to loss of visual acuity and field in one eye, blindness usually occur rapidly.
 Fundus examination showing pale optic disc with haemorrhages, but these changes may take 24-36 hours to develop (fundi may initially appear normal).
Once blindness has occurred steroid therapy of no value other than preventing blindness in the other eye.

 - Arthralgia.
 - Jaw claudication brought on by chewing or talking due to ischaemia of the masseters.
 - Tenderness of the scalp (combing the hair may be painful).
 - Transient ischaemic attacks, brain stem infarcts and hemiparesis may occur.

Investigations

• High TLC,  high ESR ,+ ve CRP (ESR may be normal so CRP is helpful in this situation).
• Temporal artery biopsy showing, necrosis of media with inflammatory cells e.g Iympocytes and plasma cells, negative biopsy does not exclude the diagnosis.

N.B
O1d age with severe headache on one side + tender temporal or
occipital arteries ---->  Ask for ESR  ----> If  High  (GCA must be suspected) ---->
Give steroid prednisolone 60 mg/d before the result of investigations to prevent visual loss.
• So new onset of headache in old persons should raise the suspicion of giant cell arteritis.
• The elevated ESR remains a sine qua non for the diagnosis of giant cell arteritis.

Treatment

• Good prognosis with treatment.
• Prednisolon 60 mg / day, it produces dramatic response within 24-48 hours.
It must be started early for fear of blindness.
• The steroid dose can be tapered with clinical and laboratory improvement, maintenance therapy may be required for at least one year .

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