Giant cell arteritis - Revision history

Aidan: formatting

2025-07-04T18:32:57Z

formatting

@@ Line 1: / Line 1: @@
 *[[Large-vessel vasculitis]] that occurs in older age and is associated with polymyalgia rheumatica
-==Epidemiology==
+=== Epidemiology ===
 *Most common systemic vasculitis in North America
-==Pathophysiology==
+=== Pathophysiology ===
 *Granulomatous inflammation of the aortic arch and extracranial carotid artery
 ==Clinical Manifestations==
@@ Line 30: / Line 17: @@
 *Jaw claudication
 *Visual loss
 ==Investigations==
@@ Line 56: / Line 47: @@
 ***Negative: treat based on MD diagnosis (biopsy-negative GCA or other)
 ***Positive: treat as GCA
 ==Management==
@@ Line 69: / Line 69: @@
 *Follow [[ESR]] for response
 *Annual chest x-rays for the first ten years, to monitor for thoracic aortic aneurysm
 [[Category:Rheumatology]]

Aidan at 18:31, 4 July 2025

2025-07-04T18:31:57Z

← Older revision		Revision as of 18:31, 4 July 2025
Line 3:		Line 3:
	==Definition==		==Definition==

	*Large-vessel vasculitis that occurs in older age and is associated with polymyalgia rheumatica		*[[Large-vessel vasculitis]] that occurs in older age and is associated with polymyalgia rheumatica

	==Epidemiology==		==Epidemiology==
Line 19:		Line 19:
	**New localized headache		**New localized headache
	**Temporal artery tenderness or decreased temporal artery pulse		**Temporal artery tenderness or decreased temporal artery pulse
	**ESR ≥ 50 mm/h: 10-20% false negative, though		**[[ESR]] ≥ 50 mm/h: 10-20% false negative, though
	**Artery biopsy consistent with GCA: Up to 40% false negative, related to skip lesions, small biopsies, or lack of temporal artery involvement		**Artery biopsy consistent with GCA: Up to 40% false negative, related to skip lesions, small biopsies, or lack of temporal artery involvement
	*''Not'' diagnostic criteria		*''Not'' diagnostic criteria
Line 26:		Line 26:

	*After 50 years		*After 50 years
	*Headache, usually unilateral with tenderness		*[[Headache]], usually unilateral with tenderness
	*[[Polymyalgia rheumatica]] (PMR)		*[[Polymyalgia rheumatica]] (PMR)
	*Jaw claudication		*Jaw claudication
Line 59:		Line 59:
	==Management==		==Management==

	*Prednisone 0.2-0.3mg/kg/day (and appropriate screening)		*[[Prednisone]] 0.2-0.3mg/kg/day (and appropriate screening)
	**Taper over 2 years, dropping by 5mg/d over a few weeks then slowing down		**Taper over 2 years, dropping by 5mg/d over a few weeks then slowing down
	**Often aren't able to taper off altogether		**Often aren't able to taper off altogether
	*Low-dose ASA for cardiovascular and cerebrovascular protection		*Low-dose [[ASA]] for cardiovascular and cerebrovascular protection
	*Can consider adding steroid-sparing agent		*Can consider adding steroid-sparing agent
	**Tocilizumab (IL-6 receptor)		**[[Tocilizumab]] (IL-6 receptor)
	**Maybe methotrexate		**Maybe [[methotrexate]]
	**Not MMF or other DMARDs		**Not [[MMF]] or other DMARDs
	*Follow ESR for response		*Follow [[ESR]] for response
	*Annual chest x-rays for the first ten years, to monitor for thoracic aortic aneurysm		*Annual chest x-rays for the first ten years, to monitor for thoracic aortic aneurysm

Aidan: /* Clinical Manifestations */

2021-03-11T14:32:41Z

Clinical Manifestations

← Older revision		Revision as of 14:32, 11 March 2021
Line 1:		Line 1:
	Also known as temporal arteritis		Also known as temporal arteritis

	== Definition ==		==Definition==

	* Large-vessel vasculitis that occurs in older age and is associated with polymyalgia rheumatica		*Large-vessel vasculitis that occurs in older age and is associated with polymyalgia rheumatica

	== Epidemiology ==		==Epidemiology==

	* Most common systemic vasculitis in North America		*Most common systemic vasculitis in North America

	== Pathophysiology ==		==Pathophysiology==

	* Granulomatous inflammation of the aortic arch and extracranial carotid artery		*Granulomatous inflammation of the aortic arch and extracranial carotid artery

	== ACR Classification Criteria ==		==ACR Classification Criteria==

	* Requires 3 of 5 criteria		*Requires 3 of 5 criteria
	** Age ≥50 years		**Age ≥50 years
	** New localized headache		**New localized headache
	** Temporal artery tenderness or decreased temporal artery pulse		**Temporal artery tenderness or decreased temporal artery pulse
	** ESR ≥ 50 mm/h: 10-20% false negative, though		**ESR ≥ 50 mm/h: 10-20% false negative, though
	** Artery biopsy consistent with GCA: Up to 40% false negative, related to skip lesions, small biopsies, or lack of temporal artery involvement		**Artery biopsy consistent with GCA: Up to 40% false negative, related to skip lesions, small biopsies, or lack of temporal artery involvement
	* ''Not'' diagnostic criteria		*''Not'' diagnostic criteria

	== Clinical Manifestations ==		==Clinical Manifestations==

	* After 50 years		*After 50 years
	* Headache, usually unilateral with tenderness		*Headache, usually unilateral with tenderness
	* Polymyalgia rheumatica (PMR)		*[[Polymyalgia rheumatica]] (PMR)
	* Jaw claudication		*Jaw claudication
	* Visual loss		*Visual loss

	== Investigations ==		==Investigations==

	* Temporal artery biopsy		*Temporal artery biopsy
	** Shows mononuclear cell infiltrate with granulomatous inflammation, and usually multinucleated giant cells		**Shows mononuclear cell infiltrate with granulomatous inflammation, and usually multinucleated giant cells
	** Findings are still visible 6-12mo after starting therapy		**Findings are still visible 6-12mo after starting therapy
	* Ultrasound of temporal arteries		*Ultrasound of temporal arteries
	** Looking for "halo sign" of hypoechoic ring around Doppler flow		**Looking for "halo sign" of hypoechoic ring around Doppler flow
	** Sn 55-100%, Sp 78-100% (more specific than sensitive)		**Sn 55-100%, Sp 78-100% (more specific than sensitive)
	** Disappears quickly with treatment		**Disappears quickly with treatment
	* MRI scalp arteries		*MRI scalp arteries

	=== McMaster Workup ===		===McMaster Workup===

	* Initial investigation with ultrasound; if positive halo sign, can skip the rest		*Initial investigation with ultrasound; if positive halo sign, can skip the rest
	* Low or moderate		*Low or moderate
	** Scalp artery MRI		**Scalp artery MRI
	*** Normal: treat based on MD diagnosis		***Normal: treat based on MD diagnosis
	*** Abnormal		***Abnormal
	**** Temporal artery biopsy		****Temporal artery biopsy
	***** Negative: treat based on MD diagnosis (biopsy-negative GCA or other)		*****Negative: treat based on MD diagnosis (biopsy-negative GCA or other)
	***** Positive: treat as GCA		*****Positive: treat as GCA
	* High		*High
	** Temporal artery biopsy		**Temporal artery biopsy
	*** Negative: treat based on MD diagnosis (biopsy-negative GCA or other)		***Negative: treat based on MD diagnosis (biopsy-negative GCA or other)
	*** Positive: treat as GCA		***Positive: treat as GCA

	== Management ==		==Management==

	* Prednisone 0.2-0.3mg/kg/day (and appropriate screening)		*Prednisone 0.2-0.3mg/kg/day (and appropriate screening)
	** Taper over 2 years, dropping by 5mg/d over a few weeks then slowing down		**Taper over 2 years, dropping by 5mg/d over a few weeks then slowing down
	** Often aren't able to taper off altogether		**Often aren't able to taper off altogether
	* Low-dose ASA for cardiovascular and cerebrovascular protection		*Low-dose ASA for cardiovascular and cerebrovascular protection
	* Can consider adding steroid-sparing agent		*Can consider adding steroid-sparing agent
	** Tocilizumab (IL-6 receptor)		**Tocilizumab (IL-6 receptor)
	** Maybe methotrexate		**Maybe methotrexate
	** Not MMF or other DMARDs		**Not MMF or other DMARDs
	* Follow ESR for response		*Follow ESR for response
	* Annual chest x-rays for the first ten years, to monitor for thoracic aortic aneurysm		*Annual chest x-rays for the first ten years, to monitor for thoracic aortic aneurysm

	== Prognosis ==		==Prognosis==

	* Cycles of flares and remissions requiring adjustment in prednisone		*Cycles of flares and remissions requiring adjustment in prednisone
	* Very few can safely taper off of steroids altogether		*Very few can safely taper off of steroids altogether

	[[Category:Rheumatology]]		[[Category:Rheumatology]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-15T00:36:58Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 00:36, 15 July 2020
Line 23:		Line 23:
	* ''Not'' diagnostic criteria		* ''Not'' diagnostic criteria

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* After 50 years		* After 50 years

Maintenance script: Imported from text file

2020-07-04T01:17:36Z

Imported from text file

New page

Also known as temporal arteritis

== Definition ==

* Large-vessel vasculitis that occurs in older age and is associated with polymyalgia rheumatica

== Epidemiology ==

* Most common systemic vasculitis in North America

== Pathophysiology ==

* Granulomatous inflammation of the aortic arch and extracranial carotid artery

== ACR Classification Criteria ==

* Requires 3 of 5 criteria
** Age ≥50 years
** New localized headache
** Temporal artery tenderness or decreased temporal artery pulse
** ESR ≥ 50 mm/h: 10-20% false negative, though
** Artery biopsy consistent with GCA: Up to 40% false negative, related to skip lesions, small biopsies, or lack of temporal artery involvement
* ''Not'' diagnostic criteria

== Clinical Presentation ==

* After 50 years
* Headache, usually unilateral with tenderness
* Polymyalgia rheumatica (PMR)
* Jaw claudication
* Visual loss

== Investigations ==

* Temporal artery biopsy
** Shows mononuclear cell infiltrate with granulomatous inflammation, and usually multinucleated giant cells
** Findings are still visible 6-12mo after starting therapy
* Ultrasound of temporal arteries
** Looking for "halo sign" of hypoechoic ring around Doppler flow
** Sn 55-100%, Sp 78-100% (more specific than sensitive)
** Disappears quickly with treatment
* MRI scalp arteries

=== McMaster Workup ===

* Initial investigation with ultrasound; if positive halo sign, can skip the rest
* Low or moderate
** Scalp artery MRI
*** Normal: treat based on MD diagnosis
*** Abnormal
**** Temporal artery biopsy
***** Negative: treat based on MD diagnosis (biopsy-negative GCA or other)
***** Positive: treat as GCA
* High
** Temporal artery biopsy
*** Negative: treat based on MD diagnosis (biopsy-negative GCA or other)
*** Positive: treat as GCA

== Management ==

* Prednisone 0.2-0.3mg/kg/day (and appropriate screening)
** Taper over 2 years, dropping by 5mg/d over a few weeks then slowing down
** Often aren't able to taper off altogether
* Low-dose ASA for cardiovascular and cerebrovascular protection
* Can consider adding steroid-sparing agent
** Tocilizumab (IL-6 receptor)
** Maybe methotrexate
** Not MMF or other DMARDs
* Follow ESR for response
* Annual chest x-rays for the first ten years, to monitor for thoracic aortic aneurysm

== Prognosis ==

* Cycles of flares and remissions requiring adjustment in prednisone
* Very few can safely taper off of steroids altogether

[[Category:Rheumatology]]