Giant cell arteritis

Abstract

#### Case scenario A previously fit and well 72 year old man presented to his general practitioner after several months of malaise and weight loss. When asked about any pain, he pointed to his left scalp as being painful. Examination was normal except that his left temporal artery was not palpable. Suspecting giant cell arteritis, the GP started 40 mg prednisolone and requested an erythrocyte sedimentation rate, which was 86 mm/h. The symptoms largely disappeared in 48 hours. She also referred the patient for a temporal artery biopsy, which showed giant cell arteritis. Giant cell arteritis affects large and medium sized arteries, often branches of the external carotid artery but also the ciliary and retinal arteries. The symptoms are caused by local ischaemia due to endovascular damage and cytokine mediated systemic illness. There is considerable overlap with polymyalgia rheumatica: 16-21% of patients with polymyalgia rheumatica have giant cell arteritis on temporal artery biopsy, and symptoms of polymyalgia rheumatica are present in 40-60% of patients with giant cell arteritis.1 #### How common is it? A systematic review analysed the presenting clinical features in a mixture of studies with a total of 1435 cases of giant cell arteritis.3 The sensitivity of individual clinical features was relatively …