Giant Cell arteritis

Posted On May 17, 2020

This is commonly known as temporal arteritis, is a chronic granulomatous vasculitis of medium to large size vessels.

Epidemiology

  • Usually after 50 years old
  • Mean age of onset 70 years old
  • Woman 6 times more often than man
  • Woman total life time risk is 1%

Clinical

  • Insidious onset, over weeks
  • Symptoms may wax and wane
  • Headache with scalp tenderness
  • 30% has unilateral or bilateral vision loss
  • Limb weakness, fever
  • Weight loss, night sweats, malaise, anemia
  • Sore throat, tongue pain, jaw claudication, siadh
  • Has polymyalgia rheumatica in 50%
    • muscle weakness, morning stiffness
    • shoulder and pelvic muscles affected

Diagnosis: 3 of following 5

  • Age > 50 years old
  • New onset localized headache
  • Temporal artery tenderness or decreased pulse
  • ESR > 50
  • Biopsy positive

Differential diagnosis

  • Takayasu arteritis:
    • begins before age 40
    • may have renal artery stenosis with renovascular Hypertension
  • Polyarteritis nodosa:
    • kidney, skin, joints, muscles, nerves and GI commonly involved.
  • Primary angiitis of CNS: inflammation of blood vessels of brain spinal cord and meninges, other organs not involved.

Treatment

  • For those without vision loss
    • Prednisone 1 mg/kg up to 100 mg qd for 2-4 weeks, then taper by 10 mg/d every 2 weeks if tolerated.
    • When down to 20 mg/day, taper by 2.5 mg per day every 2 weeks
    • Monitor ESR and CRP
  • With vision loss
    • IV solumedrol 500-1000 mg iv qd for 3 days
    • followed by Prednisone 1 mg/kg/day up to 60 mg qd.