Giant Cell Arteritis

Posted by e-Medical PPT Saturday, July 21, 2012
Chronic vasculitis of medium and large vessels
More common at age>50, incidence peaks at 70-80
Affects women more often than men, 2:1

Pathophysiology
Vasculitis of extracranial branches of aorta,  spares intracranial branches
Transmural inflammation-> intimal hyperplasia-> luminal occlusion
Symptoms are due to end-organ ischemia

Histology
Granulomatous inflammation with giant cells in junction between intima and media. (50%)
Inflammatory infiltrate usually focal and segmental

Presentation
Onset usually gradual, but may be abrupt
Most frequent symptom: headache (2/3)
Usually accompanied by syndrome of systemic inflammation: fever, malaise, weight loss, anorexia (40%)
Frequently associated with polymyalgia rheumatica (39%)

Diagnosis
Temporal artery biopsy should be performed in all patients with suspected GCA
Sensitivity of unilateral biopsy: 88%
Negative Predictive Value: 91%
Bilateral biopsies increase sensitivity, may be prudent
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