Giant cell arteritis (cranial/temporal arteritis)

Pathology:

• Is a granulomatous arteritis of unknown aetiology
• Affects mainly those >60 years of age
• Other forms of arteritis can present with similar features, e.g:
• SLE
• Polyarteritis nodosa

• Very closely related to polymyalgia rheumatica (both can occur in the same patient)

Clinical features:

Headache:

• Pain is felt over the inflamed artery (superficial, temporal or occipital)
• Touching the skin over the artery causes pain (e.g. brushing hair)

Facial pain:

• Jaw, face and mouth pain occurs
• Worse on eating (jaw claudication)
• Opening the mouth and protruding the tongue is difficult

Visual problems:

• 25% of untreated cases go blind (due to inflammation/occlusion of the ciliary and/or central retinal artery)

Systemic features:

• Polymyalgia rheumatica (occurs in 50% of cases):
• Generalized muscle pains
• Proximal limb girdle pain and tenderness
• NO joint effusions

• Weight loss
• Sweating
• Malaise

Investigations:

• Raised ESR
• Raised CRP
• Albumin reduced (occasionally)

Diagnosis is confirmed by a biopsy of a superficial temporal artery

Treatment:

High dose steroids should be started immediately (e.g. prednisolone 60-100mg daily), even before the biopsy

The dose is reduced as the ESR falls

It is usually possible to stop steroid therapy after some months to several years