Giant cell arteritis is inflammation of large and medium arteries, especially the branches of the carotid artery in the head, seen almost only in people over 50. It can cause blindness within days, so high-dose steroids start as soon as it is suspected, before the biopsy result.
Key symptoms
- New headache, often at the temples
- Scalp tenderness, for example when combing hair
- Jaw pain when chewing (jaw claudication)
- Vision changes: blurring, double vision or sudden vision loss
- Fever, weight loss, fatigue, or shoulder and hip stiffness (polymyalgia rheumatica)
What you find on exam
- Tender, thickened temporal artery with a weak pulse
- Visual acuity, visual fields and fundoscopy
- Pulses and blood pressure in both arms; listen for bruits
- Shoulder and hip range of motion
Tests
- ESR and CRP, usually raised
- Blood count: anemia and high platelets
- Temporal artery biopsy, or ultrasound showing a halo sign
- Imaging of the aorta (CT, MR or PET) for large-vessel disease
Treatment basics
- Start prednisone 40 to 60 mg a day right away
- IV methylprednisolone if vision is affected
- Tocilizumab to spare steroids
- Bone protection: calcium, vitamin D, often a bisphosphonate
- Slow steroid taper guided by symptoms, ESR and CRP
Red flags
- Sudden vision loss or double vision
- Jaw claudication
- Stroke symptoms
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.