Giant Cell Arteritis

Multisystem Processes & Disorders


Clinicals - History

Fact Explanation
{"ops":[{"insert":"Headache"},{"insert":"\n"}]}
{"ops":[{"insert":"Classically presents with temporal tenderness. However the quality of the headache can vary widely in practice. A high index of suspicion should be maintained in patients over the age of 50, particularly if there is associated visual loss.\n\nAs GCA is a vasculitic process, inflammation results in pain that manifests as headache."}]}
{"ops":[{"insert":"Scalp tenderness"},{"insert":"\n"}]}
{"ops":[{"insert":"Scalp tenderness is a common complaint amongst patients with GCA. Patients should be specifically asked if combing or brushing their hair leads to scalp pain.\n\nThe pathophysiology for this is thought to be due to relative ischemia."}]}
{"ops":[{"insert":"Jaw claudication"},{"insert":"\n"}]}
{"ops":[{"insert":"Occurs with chewing and can be severe. Patients often require direct questioning for this symptom.\n\nThe pathophysiology of this is thought to be due to relative ischemia."}]}
{"ops":[{"insert":"Constitutional symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"Systemic symptoms such as fever, fatigue, weight loss can occur.\n\nThis is thought to be due to the activation of inflammation in GCA. There is emerging evidence about the role of T cell activation and the cytokine cascade in the promotion of inflammation."}]}
{"ops":[{"insert":"Visual loss"},{"insert":"\n"}]}
{"ops":[{"insert":"Visual loss is an important symptom to ask about, as this can be irreversible if GCA is not recognised and treated promptly.\n\nPotential causes of vision loss include anterior ischemic optic neuropathy, central retinal artery occlusion, posterior ischemic optic neuropathy or cerebral ischemia. Of these, anterior ischemic optic neuropathy is the most common, accounting for over 80% of visual loss in GCA."}]}
{"ops":[{"insert":"Symptoms of polymyalgia rheumatica"},{"insert":"\n"}]}
{"ops":[{"insert":"Roughly 50% of patients with GCA have polymyalgia rheumatica (PMR); conversely, 15% of patients with PMR have GCA. Symptoms of PMR include shoulder girdle or hip pain and morning stiffness.\n\nThe exact cause for the overlap between these syndromes is unknown, but it is thought that they may have a shared pathophysiology and that they may be different manifestations of the same disease process."}]}
{"ops":[{"insert":"Chest pain"},{"insert":"\n"}]}
{"ops":[{"insert":"Aortitis, aortic dissection, and aortic aneurysms are uncommon complications of GCA, but can be devastating if missed."}]}
{"ops":[{"insert":"Symptoms of stroke"},{"insert":"\n"}]}
{"ops":[{"insert":"Stroke is an uncommon complication of GCA. This is due to involvement of the large vessels supplying the brain. The vertobrobasilar territory is most often affected."}]}
{"ops":[{"insert":"Demographics and age"},{"insert":"\n"}]}
{"ops":[{"insert":"GCA occurs in persons \u003E50 years of age and is more common in patients older than 70; it is also more common in females.\n\nThere is an increase in the incidence of GCA with latitude in the Northern hemisphere, with a particularly high incidence in Northern American and Scandinavian populations. The exact cause for this is unclear."}]}
{"ops":[{"insert":"Headache"},{"insert":"\n"}]}
{"ops":[{"insert":"Classically presents with temporal tenderness. However the quality of the headache can vary widely in practice. A high index of suspicion should be maintained in patients over the age of 50, particularly if there is associated visual loss.\n\nAs GCA is a vasculitic process, inflammation results in pain that manifests as headache."}]}
{"ops":[{"insert":"Scalp tenderness"},{"insert":"\n"}]}
{"ops":[{"insert":"Scalp tenderness is a common complaint amongst patients with GCA. Patients should be specifically asked if combing or brushing their hair leads to scalp pain.\n\nThe pathophysiology for this is thought to be due to relative ischemia."}]}
{"ops":[{"insert":"Jaw claudication"},{"insert":"\n"}]}
{"ops":[{"insert":"Occurs with chewing and can be severe. Patients often require direct questioning for this symptom.\n\nThe pathophysiology of this is thought to be due to relative ischemia."}]}
{"ops":[{"insert":"Constitutional symptoms"},{"insert":"\n"}]}
{"ops":[{"insert":"Systemic symptoms such as fever, fatigue, weight loss can occur.\n\nThis is thought to be due to the activation of inflammation in GCA. There is emerging evidence about the role of T cell activation and the cytokine cascade in the promotion of inflammation."}]}
{"ops":[{"insert":"Visual loss"},{"insert":"\n"}]}
{"ops":[{"insert":"Visual loss is an important symptom to ask about, as this can be irreversible if GCA is not recognised and treated promptly.\n\nPotential causes of vision loss include anterior ischemic optic neuropathy, central retinal artery occlusion, posterior ischemic optic neuropathy or cerebral ischemia. Of these, anterior ischemic optic neuropathy is the most common, accounting for over 80% of visual loss in GCA."}]}
{"ops":[{"insert":"Symptoms of polymyalgia rheumatica"},{"insert":"\n"}]}
{"ops":[{"insert":"Roughly 50% of patients with GCA have polymyalgia rheumatica (PMR); conversely, 15% of patients with PMR have GCA. Symptoms of PMR include shoulder girdle or hip pain and morning stiffness.\n\nThe exact cause for the overlap between these syndromes is unknown, but it is thought that they may have a shared pathophysiology and that they may be different manifestations of the same disease process."}]}
{"ops":[{"insert":"Chest pain"},{"insert":"\n"}]}
{"ops":[{"insert":"Aortitis, aortic dissection, and aortic aneurysms are uncommon complications of GCA, but can be devastating if missed."}]}
{"ops":[{"insert":"Symptoms of stroke"},{"insert":"\n"}]}
{"ops":[{"insert":"Stroke is an uncommon complication of GCA. This is due to involvement of the large vessels supplying the brain. The vertobrobasilar territory is most often affected."}]}
{"ops":[{"insert":"Demographics and age"},{"insert":"\n"}]}
{"ops":[{"insert":"GCA occurs in persons \u003E50 years of age and is more common in patients older than 70; it is also more common in females.\n\nThere is an increase in the incidence of GCA with latitude in the Northern hemisphere, with a particularly high incidence in Northern American and Scandinavian populations. The exact cause for this is unclear."}]}

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