Vascular

Question 1

What is giant cell arteritis? (GCA)

Answer 1

AKA temporal arteritis, is a type of chronic vasculitis characterised by granulomatous inflammation in the walls of medium and large arteries.

Question 2

Which arteries are most commonly affected in giant cell arteritis?

Answer 2

The extra cranial branches of the carotid artery and branches of the ophthalmic artery, such as short ciliary branches, are preferentially involved, although the aorta and its major branches may also be affected.

Question 3

What is the cause of giant cell arteritis?

Answer 3

The cause is unknown

Question 4

What is the annual incidence of GCA in the UK?

Answer 4

20 per 100,000

Question 5

What is the mean age of onset of GCA?

Answer 5

70 years of age

Question 6

How many more times likely is GCA in white people compared to black people?

Answer 6

7 times more common. ….particularly common in Scandinavian people

Question 7

Which gender is GCA more common in?

Answer 7

3 times more common in women than men

Question 8

What are the complications of GCA? (8)

Answer 8

1. Vision loss
2. Large artery complications e.g. AAA, aortic dissection, large artery stenosis, aortic regurgitation
3. CVD e.g. MI, heart failure, stroke
4. Peripheral neuropathy
5. Depression
6. Deafness
7. Encephalopathy and confusion
8. Complications of long-term corticosteroid use

Question 9

How may a GCA present? (6)

Answer 9

In someone aged 50 years of over with:

1. New onset localised headache that is usually unilateral, in the temporal area
2. A temporal artery tenderness, thickening or nodularity.
3. Fever - systemic features (weight loss, fatigue too)
4. Scalp tenderness
5. Intermittent jaw claudication
6. Visual disturbances

Question 10

What treatment should be started in someone with suspected/confirmed GCA? (3)

Answer 10

1. Oral corticosteroids - prednisolone, while awaiting temporal artery biopsy
2. Also start aspirin 75mg daily
3. Start a PPI - omeprazole 20mg daily

Question 11

What are the differentials for GCA? (5)

Answer 11

1. Herpes zoster
2. Cluster headache or migraine
3. Acute angle-close glaucoma
4. Ankylosing spondylitis
5. Retinal TIA and embolic visual deficits