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.