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Vasculitic Syndrome: Giant Cell Arteritis (aka Temporal Arteritis) Clinical Presentation:
Symptoms depend on distribution of affected arteries…may include:
Prominent headache (from temporal a. involvement)
Claudication of jaw while chewing (facial a. involvement)
50% patients have visual impairment (ophthalmic a. involvement) – irreversible blindness can result
With Giant Cell Arteritis, may find diminished temporal pulses.
Etiology & some Epidemiology:
Associated with Polymyalgia Rheumatica (an inflammatory condition)
Uncommon disease (24/100,000).
Most often seen in patients > 55 years old.
65% patients are females.
Giant Cell Arteritis is usually a self-limiting disease of 1-5 years.
Giant Cell Arteritis is a disease of medium to large size arteries: common involvement of cranial vessels, aortic arch and its branches.
Histologic examination of affected areas of arteries shows:
Focal necrosis with Granulomas containing Multinucleated Giant Cells
Distal to the involved vessel, get ischemia that damages tissues.
Erythrocyte Sedimentation Rate: elevated (marker of inflammation)
C-reactive Protein: elevated (marker of inflammation)
Biopsy of involved vessel (usually a temporal artery): used to diagnose Giant Cell Arteritis
Ultrasound (US): can support diagnosis if see a hypoechoic (def: region in US image where echoes are weaker or
fewer than normal) halo around lumen with arterial stenosis and/or occlusion
DON’T WAIT FOR BIOPSY RESULTS BEFORE TREATING.
Go ahead and give high-dose systemic steroids to treat vasculitis and prevent visual damage