Giant cell arteretis (GCA)

What is GCA?

Also called temporal arteritis, because of the frequent involvement of the temporal artery. Also known as “cranial arteritis” and “Horton’s disease”. The name (giant cell arteritis) reflects the type of inflammatory cell involved.

It is an inflammatory autoimmune disease of large blood vessels.

What are the symptoms?

This type of arteritis causes the arteries in the head, neck, and arm area to swell to abnormal sizes.

Typical patient population

  • Age over 50, most common around 70
  • ~70% Females
  • Northern European descent
  • Normal life expectancy
  • 50% also diagnosed with polymyalgia rheumatica (PMR)

Diagnosis

Physical exam

  • Palpation of the head reveals prominent temporal arteries with or without pulsation.
  • The temporal area may be tender.
  • Decreased pulses may be found throughout the body
  • Evidence of ischemia may be noted on fundal exam.
  • Bruits may be heard over the subclavian and axillary arteries

Laboratory tests

  • Erythrocyte sedimentation rate, an inflammatory marker, > 60 mm/h (normal 1–40 mm/h)
  • C-reactive protein, another inflammatory marker, may be elevated
  • LFTs, liver function tests, are abnormal particularly raised ALP- alkaline phosphatase
  • Platelets may also be elevated

How can it be treated?

  • Corticosteroids
    • Prednisone
  • IL-6 inhibitors
    • Tocilizumab

References

  • https://en.wikipedia.org/wiki/Giant_cell_arteritis