Giant cell arteritis

• Published in: Canadian Medical Association journal (CMAJ) Vol. 183; no. 5; p. 581
• Main Authors: Belliveau, Michel J, Ten Hove, Martin W
• Format: Journal Article
• Language: English
• Published: Canada CMA Joule Inc 22-03-2011; CMA Impact, Inc; Canadian Medical Association
• Subjects: Biopsy, Needle; Blood Sedimentation; Blood vessels; C-Reactive Protein - analysis; Care and treatment; Diagnosis; Female; Giant cell arteritis; Giant Cell Arteritis - diagnosis; Humans; Inflammatory diseases; Male; Medical diagnosis; Medical treatment; Patient outcomes; Physiological aspects; Platelet Count; Practice; Practice Guidelines as Topic; Temporal Arteries - pathology; Vision Disorders - diagnosis; Canada
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.100920

Permanent, severe loss of vision is a feared complication; however, it is not the sole possible devastating outcome of giant cell arteritis. Myocardial infarction, ischemic stroke and limb gangrene may also occur. Thor - acic aortic aneurysms are seen over 17 times more often in patients with giant cell arteritis than in age-matched controls.1 A thorough history is the most important component of diagnosis. High clinical suspicion can trump a negative biopsy. Neck pain and claudication of the jaw are most suggestive of giant cell arteritis.2 Headache and myalgia are common symptoms but are less helpful in establishing a diagnosis. (Appendix 1, available at www.cmaj .ca /cgi /content /full /cmaj .100920/DC1, highlights the likelihood of diagnosing giant cell arteritis based on several key features.) Progressive loss of vision may occur despite immediate initiation of high doses of oral prednisone (60-100 mg or about 1 mg/kg).5 In these instances, switching to intravenous corticosteroid treatment (e.g., 250 mg of methylprednisolone four times daily) for three days is a common practice. Retrospective studies suggest that adding acetylsalicylic acid may reduce the ischemic complications of giant cell arteritis.6