Giant Cell Arteritis
Giant Cell Arteritis (also called Temporal arteritis)
Giant Cell Arteritis is an autoimmune condition which can lead
to inflammation of the blood vessels (vasculitis) of the head and
neck, causing headache, tenderness over the scalp, pain in the jaw
or ear, shoulder and hip girdle pain and stiffness. It usually
presents in people over the age of 50. In 20% of cases GCA can
present with visual loss or change, this can be blurred vision,
loss of vision, feeling of a curtain coming down over your vision,
double vision, change in colour. If you have any visual symptoms
such as these please go urgently to the eye casualty at the Bristol
Eye Hospital. If you have any symptoms of GCA without visual change
please contact your GP urgently or out of hours services urgently
in the evening or weekend.
If you have visual involvement you will be seen by ophthalmology
and usually treated as an inpatient if you require intravenous
glucocorticoids (i.e. steroids via a drip). They will arrange an
urgent ultrasound and biopsy of your temporal artery and examine
the back of your eyes for features of GCA. They will continue to
monitor your care and treat you with a reducing course of
prednisolone (steroids).
People with symptoms of GCA without visual change should be
referred urgently by their GP to the rheumatology department via
the UHBristol switchboard. Treatment is started immediately with
prednisolone (steroids) to prevent sight loss. We will arrange
urgent ultrasound (usually within 48 hours) and aim to review in
clinic in 7 days. If the ultrasound is positive, people will
continue on a reducing course of prednisolone over the next 12-18
months. If the scan is negative and there is a moderate or high
clinical suspicion then a temporal artery biopsy will be arranged
to confirm the diagnosis.
We now know that there is a sub-type of GCA which affects the
large blood vessels of the chest and abdomen and this is called
large vessel vasculitis-GCA. This can cause flu-like symptoms,
weight loss, stiffness and pain in the shoulders and hips, and high
levels of inflammation on blood testing. The diagnosis of large
vessel vasculitis is often made on imaging, such as a CT scan or
PET scan. Treatment is with a reducing course of prednisolone and
an additional steroid-sparing medication called Methotrexate.
At UHBristol we host a regional MDT for consideration of
Tocilizumab in GCA for people who fail treatment or relapse with
first line treatment. Doctors from rheumatology and ophthalmology
are part of this MDT and often "share care" of individual patients
to get the optimal management plan. UHBristol Rheumatology
department is also an NHS England specialist centre for Vasculitis
and participates in the UKIVAS registry study and other
observational and interventional trials.
Information for patients
https://www.nhs.uk/conditions/temporal-arteritis/
https://www.vasculitis.org.uk/about-vasculitis/giant-cell-arteritis-temporal-arteritis
https://www.hopkinsvasculitis.org/types-vasculitis/giant-cell-arteritis/
Information for clinicians on referral pathway at
UHBristol:
http://remedy.bnssgccg.nhs.uk/adults/rheumatology/giant-cell-arteritis/
