Giant Cell Arteritis (Temporal Arteritis)

Pathology

Systemic vasculitis affecting medium to large arteries is at the heart of pathogenesis, which is a long-term inflammatory process resulting in the production of various cytokines.

Aetiology

• Giant cell arteritis is frequently seen in conjunction with polymyalgia rheumatica.
• Affects mostly people aged over 50 years old, with more females than males affected.

Symptoms

• Headache
• Scalp tenderness
• Sudden blindness in one eye
• Fatigue
• Weight loss
• Fever
• Jaw claudication

Signs

Physical exam may detect tenderness over the temporal arteries, as well as reduced visual acuity.

Investigations

• Blood tests, such as ESR
• Temporal Artery Biopsy, which may show an inflammatory infiltrate involving the entire vessel wall

Treatment

Medical treatment typically involves high doses of corticosteroids, which should be maintained only as long as symptoms resolve, followed by a gradual taper to a maintenance dosage over several months.

Complications

• Blindness
• Aortitis
• Aortic dissection
• Aortic aneurysm

Prognosis

Relapse is not uncommon in giant cell arteritis and should be guarded against.