see: [Eye and ear GCA guideline](x-devonthink-item://50585721-A310-49AE-8DEB-0AF6304AD61A) > [!key points] > - systemic vasculitis affecting medium and large arteries > - significant ocular and systemic morbidity > - **ocular emergency risk of blindness** - more common in caucasian women - average age of onset ~70 years old; most pts > 60, *rare* <50 > [!treatment] Diagnostic criteria > presence of any 3 of the following has 90-95% sensitivity and specificity: > - age > 50 > - new-onset localised headache > - tenderness or decreased pulse of temporal artery > - ESR >50 > - temporal artery biopsy positive for arteritis ## pathology - chronic inflammatory disease of large blood vessels - granulomatous inflammation of the intima and inner part of the media, focal and segmental - more common in elderly - usually spares intracranial arteries - *aorta and branches including coronaries may be affected* - granulomatous infl ## history - systemic symptoms: - symptoms of inflammation: fever, night sweats, fatigue, weight loss preceding ophthalmic symptoms - headache (temporal), scalp tenderness, ==jaw claudication==, proximal limb girdle pain and stiffness (polymyalgia rheumatica) - ==[[Painful loss of vision]]== ; can get [[Central retinal artery occlusion|CRAO]] - [[Diplopia]] - ocular pain - ==associated with [[Polymyalgia rheumatica|PMR]]== - 40-50% of patients who have giant cell arteritis will have polymyalgia rheumatica - ~15% of pts with PMR will have giant cell arteritis - ↑ risk in smokers ## exam - visual acuity <6/60 - *ischaemic optic neuropathy* (Arteritic anterior ischaemic optic neuropathy is cause of permanent visual loss in 90% of pts with GCA) - signs of optic nerve dysfunction: - ==[[Relative afferent pupillary defect]]== - loss of colour vision - optic nerve that is chalky white oedema specific for GCA ## investigations - *CRP* -- more accurate marker if disease activity than ESR - *ESR* -- >20 in males and >30 in females in 85% of cases (usually >50) - 90% specific if >100 - FBC -- plt >400, normochromic normocytic anaemia in 45% of cases - LFTs abnormal ~30% of cases ## Complications - visual loss (permanent if not adequately treated) - aneurysms and dissections of thoracic aorta - coronary occlusion - [[vertigo#vertebrobasilar insufficiency|vertebrobasilar stroke (posterior stroke)]] ## management - refer neuro-ophthal - IV *steroids* in pts with vision loss, MI, or cerebrovascular ischamia: **methylprednisolone 1000mg** od for three days - oral steroids if no sight threatening issues **prednisolone 1mg/kg** up to 70mg - ulcer ppx (PPI eg pantoprazole 20mg od) - organise temporal artery biopsy - admit