Giant cell arteritis (GCA)

Giant cell arteritis (GCA), also known as temporal arteritis, is a vasculitis that primarily affects medium and large arteries, especially the branches of the carotid artery. It commonly involves the temporal arteries, hence the name temporal arteritis.

The exact cause of GCA is unknown, but it is believed to be an autoimmune disorder. The immune system is thought to attack the blood vessels, leading to inflammation and narrowing of the affected arteries. Genetic and environmental factors may also contribute to the development of GCA.

The most common manifestations of GCA are headache, scalp tenderness, jaw claudication (pain with chewing), and visual disturbances, such as blurred vision or sudden visual loss. Constitutional symptoms like fever, fatigue, and weight loss may also be present. It is important to consider GCA in the differential diagnosis of any patient over the age of 50 presenting with these symptoms.

Diagnosis of GCA is based on a combination of clinical features, laboratory tests, and imaging studies. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are commonly elevated in GCA, although these markers are non-specific. Temporal artery biopsy can confirm the diagnosis by demonstrating characteristic findings of transmural inflammation and giant cells.

Treatment:

Prednisolone, 40-60 mg (not < 0.75 mg/kg) for 4 weeks (or until symptoms and laboratory abnormalities resolve), then

Reduce dose by 10 mg every 2 weeks to 20 mg, then.

Reduce dose by 2.5 mg every 2-4 weeks to 10 mg, then.

Reduce dose by 1 mg every 1-2 months, provided no relapse occurs.

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