Concise guidance: diagnosis and management of giant cell arteritis

Abstract

-Giant cell arteritis (GCA) or temporal arteritis (TA) with polymyalgia rheumatica (PMR) is among the most common reasons for long-term steroid prescription. GCA is a critically ischaemic disease, the most common form of vasculitis and should be treated as a medical emergency. Visual loss occurs in up to a fifth of patients, which may be preventable by prompt recognition and treatment. The British Society for Rheumatology (BSR) and the British Health Professionals in Rheumatology (BHPR) have recently published guidelines on the management of PMR. The purpose of this concise guidance is to draw attention to the full guidelines to encourage the prompt diagnosis and urgent management of GCA, with emphasis on the prevention of visual loss. They provide a framework for disease assessment, immediate treatment and referral to specialist care for management and monitoring of disease activity, complications and relapse.

Use of Anti TNF-α Therapy in Systemic Vasculitis

“…Giant cell arteritis (GCA) is a most common form [22,23] as a multisystem granulomatous vasculitis predominantly targets large and medium sized arteries [24,25]. Classical disease therapy relies on a high dose of GC administration once the clinical finding is suggestive of the disease [25,26].…”

“…Classical disease therapy relies on a high dose of GC administration once the clinical finding is suggestive of the disease [25,26]. Relapse is common in 60-70% of patients thus, other therapeutic modalities are required [23,27,28]. A meta-analysis in 2014 [29], included five studies about anti TNF alpha agents in GCA.…”

Large-Vessel Giant Cell Arteritis Presenting as Back Pain with Vertebral Body Infarction in a 73-year-old Caucasian Woman

“…Early diagnosis is always the goal, so symptoms such as headache, scalp pain, jaw claudication, and amaurosis fugax should alert clinicians of the possibility of GCA and lead to early confirmatory biopsy 3 . GCA is also known to occasionally present in an unusual manner, which can cause significant confusion and ultimately delay the diagnosis, as was the case with our patient.…”

The assessment of headaches on the acute medical unit: is it adequate and how could it be improved?

“…5,6,[9][10][11][12][13][14][15][16][17][18] One previously published local guideline 12 was consulted although such documents are not easily accessible, being frequently only available via hospital intranet sites. The BSUH guideline covers causes of acute primary and secondary headache presenting to the acute medical unit, except idiopathic intracranial hypertension, which has its own guideline.…”