AAION/GCA

Question 1

What disease is GCA associated with? What % of GCA patients have it?

Answer 1

Polymyalgia Rheumatica (PMR)
- 50% of GCA patients

Question 2

GCA attacks what type of vessels?

Answer 2

Medium and large sized arteries

Question 3

What are the sxs of GCA?

Answer 3

1. Fever
2. HA
3. Malaise/Weight Loss
4. Scalp tenderness
5. Jaw claudication

Question 4

A headache from GCA is worse in what 2 conditions?

Answer 4

1. At night

2. Exposure to cold

Question 5

What are the 5 patient/clinical findings of GCA?

Answer 5

1. Elderly age (>50)
2. HA
3. Temp. Art. Abnormality
4. Elevated ESR
5. Abnormal Artery Biopsy

Question 6

What % of GCA patients present with ocular involvement?

Answer 6

50%

Question 7

What are the 4 main ocular symptoms of GCA patients?

Answer 7

1. Visual Loss
2. Amaurosis Fugax
3. Diplopia
4. Eye Pain

Question 8

What percent of amaurosis fugax cases precede permanent visual loss in GCA patients?

Answer 8

50-65%

Question 9

AAIONs cause what % of GCA cases?

Answer 9

81%

Question 10

Occult GCA makes up what % of GCA cases?

Answer 10

21%

Question 11

What are the 5 lab tests for a GCA workup?

Answer 11

1. ESR Westergran
2. CRP
3. CBC w/ diff
4. Platelet Count
5. FA

Question 12

What is the norm for ESR?

Answer 12

Men = Age/2
Women = (Age + 10)/2

Question 13

What is the norm for CRP?

Answer 13

< 2.54mm/dL

Question 14

If elevated ESR and CRP, what % specificity is that for GCA?

Answer 14

97%

Question 15

What are the norm values for hemoglobin?

Answer 15

Men = 14-18
Women = 12-16

Question 16

A delay in choroidal filling time is significant for GCA when what is absent?

Answer 16

Carotid occlusion is absent

Question 17

What’s the max choroidal filling time?

Answer 17

18 secs

Question 18

In what time span should a GSTA biopsy be done?

Answer 18

within 14 days

Question 19

Positive biopsies are found in what % of GCA pts?

Answer 19

70%

Question 20

If vision is affected in one eye, what is the tx?

Answer 20

1. IV Methylprednisolone

2. Followed by oral prednisone taper

Question 21

If vision is not affected, what is the tx?

Answer 21

Oral prednisone 60-80mg daily

Question 22

What is the newest treatment for GCA?

Answer 22

Actemera (Tocilizumab)

Question 23

What type of injection is Actemera?

Answer 23

sub-cutaneous injection

Question 24

What receptor does it target?

Answer 24

IL-6 receptor

Question 25

GCA specifically targets arteries with ____. What's the inciting antigen?

Answer 25

- w/ ILM | - Elastin is inciting antigen

Question 26

What 3 cytokines are associated w/ systemic inflammation?

Answer 26

- IL-1 - IL-6 - TNF-alpha

Question 27

GCA most often attacks which branch from the common carotid?

Answer 27

External carotid artery | - specifically targets extra-cranial carotid branches

Question 28

What 2 GCA symptoms are most predictive for a + temporal artery biopsy?

Answer 28

1. Jaw cludication | 2. Neck pain

Question 29

When GCA affects the choroid, what is this called?

Answer 29

Choroidal Hypoperfusion associated w/ delayed choroidal fillling of FA

Question 30

What is the only definitive test and gold standard for testing of GCA?

Answer 30

Temporal artery biopsy

Question 31

What are the main 2 things we're looking for after a temporal artery biopsy?

Answer 31

1. Internal elastic lamina fragmentation | 2. Giant Cells

Question 32

What increases the risk of negative GSTA biopsy ?

Answer 32

Skip lesions