Giant cell arteritis

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Giant cell arteritis
Diagnosis in short

Giant cell arteritis. H&E stain.
Synonyms temporal arteritis
LM large artery with intramural inflammatory cells (often granulomatous); intimal thickening; frank destruction of arterial wall common - fibrinoid necrosis
Site large blood vessels - see vasculitides
Clinical history patient older than 50 years
Signs loss of vision, weight loss, chills, fever
Symptoms jaw claudication (classic), headache (classic), double vision, scalp tenderness
Prevalence uncommon
Blood work ESR elevated
Prognosis good if treated
Clin. DDx other causes of headache
Treatment steroids

Giant cell arteritis (abbreviated GCA), also known as temporal arteritis, is a type of large vessel vasculitis.

General

  • Classically afflicts the temporal artery.

Clinical features:

  • Classic finding: jaw claudication, in a patient older than 50 years.
  • Other findings: headache (very common),[1] vision loss or diplopia, scalp tenderness, polymyalgia, weight loss, chills, fever.

Work-up:

  • CRP, ESR, temporal artery biopsy.
    • ESR normal (>50 years old): <20 mm/hr males, <30 mm/hr females.[2]

Treatment:

  • Treat right away with high dose steroids.
    • Biopsy is confirmatory.

Microscopic

Features - as per Le et al.:[1]

  • Artery with intimal thickening.
  • Transmural inflammatory cells.
  • Giant cells.

Notes:

  • Inflammation classically granulomatous.
    • Granulomas not required for the diagnosis!
  • Often accompanied by frank destruction of the arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).

Images

  • GCA - very low mag. (WC)

  • GCA - low mag. (WC)

  • GCA - intermed. mag. (WC)

  • GCA - high mag. (WC)

  • GCA - intermed mag. (WC)

  • GCA - high mag. (WC)

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Negative

TEMPORAL ARTERY, LEFT, BIOPSY:
- MEDIUM SIZE ARTERY WITHOUT PATHOLOGIC DIAGNOSIS, SEE COMMENT.

COMMENT:
A negative biopsy does not rule out the possibility of giant cell (temporal) 
arteritis, as this may be a focal disorder. The clinical management is 
dependent upon the clinical impression.

See also

References

  1. ↑ 1.0 1.1 Le, K.; Bools, LM.; Lynn, AB.; Clancy, TV.; Hooks, WB.; Hope, WW. (Oct 2014). "The effect of temporal artery biopsy on the treatment of temporal arteritis.". Am J Surg. doi:10.1016/j.amjsurg.2014.07.007. PMID 25457237.
  2. ↑ URL: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm. Accessed on: 17 August 2012.
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