Giant cell arteritis

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

General

• Classically afflicts the temporal artery.

Clinical features:

• Classic finding: jaw claudication, in a patient older than 50 years.
• Other findings: headache, 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.

Treatment:

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

Microscopic

Features:

• Artery with intramural inflammatory cells.
  • Classically granulomatous inflammation.
    • Granulomas not required for the diagnosis!
• Destruction of arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).

Image(s):

• GCA (harvard.edu).
• GCA - several images (upmc.edu).

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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

• Vasculitides.
• Cardiovascular pathology.