GCA

Question 1

What is the pathophysiology of GCA?

Answer 1

The pathological mechanism seems to start when dendritic cells in the vessel wall recruit T cells and macrophages to form granulomatous infiltrates.

Giant-cell indicates the union of several distinct cells to form a granuloma, therefore this is a granulomatous large vessel vasculitis.

Question 2

What type of individual does GCA occur in?

Answer 2

• Elderly
• Those with PMR

Question 3

How does GCA present?

Answer 3

• Fever
• Temporal/Generalised headache
• Scalp tenderness
• Jaw Claudication - can also get tongue claudication
• Sudden painless blindness - amaurosis fugax (occlusion of the opthalmic artery)
• Dyspnoea
• Morning stiffness
• Unequal/weak pulses

Question 4

How would you investigate suspected GCA?

Answer 4

Bloods

• ESR + CRP - increased
• Platelets - increased
• Alk Phos - increased
• Hb - decreased - normocytic normochromic
• Albumin - low

Diagnosis

• Temporal Artery Biopsy - within 7 days of starting steroids

Question 5

How would you treat someone with suspected GCA?

Answer 5

• High Dose Steroids - Prednisolone 60-100mg/day - immediately
• Calcium and Vitamin D
• PPI

Question 6

What is are potential complications of GCA?

Answer 6

1. Sudden painless irreversible mono/bilateral blindness
2. Aortic dissection
3. Aortic Aneurysm

Question 7

What diagnosis would you consider if someone presented with symptoms of GCA but they were <55yrs?

Answer 7

Takayasu’s arteritis

Question 8

What are histological features of GCA?

Answer 8

• Intimal hypertrophy
• Inflammation of the intima
• Degredation of the internal elastic lamina
• Giant cells, lymphocytes and plasma cells in the internal elastic lamina

Question 9

How long does it normally take to resolve GCA?

Answer 9

12-36 months

Question 10

What dose of steroids would you start someone on with GCA?

Answer 10

60-100 mg/day oral

Question 11

If symptoms of GCA resolved on treatment, what would you consider doing?

Answer 11

Decreasing, but NOT stopping steroids