Page 337 - The Vasculitides, Volume 1: General Considerations and Systemic Vasculitis

In: The Vasculitides, Volume 1 ISBN: 978-1-63463-110-5
Editors: David S. Younger © 2015 Nova Science Publishers, Inc.

Chapter 17

Giant Cell Arteritis

Vanessa Quick, M.D. and
John Kirwan, B.Sc., M.B., B.S., M.D., F.R.C.P.?

Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, UK

Abstract

Nearly one in 130 people over the age of 50 develop giant cell arteritis putting them
at risk of sudden blindness. The disorder can be difficult to diagnose, moreover empiric
high dose glucocorticoid treatment carries the risk of potentially serious medication side
effects. Clinical acumen supported by temporal artery biopsy is the mainstay of
diagnosis. This chapter reviews the epidemiologic, clinicopathologic features, diagnosis
and treatment of giant cell arteritis, as well as the integration of temporal artery
ultrasonography and biopsy into clinical care pathways for a more efficient and reliable
diagnostic approach.

Keywords: Giant Cell Arteritis, Vasculitis, Temporal Artery Biopsy, Temporal Artery
Ultrasound

Introduction

In the 10th century, Ali ibn Isâ described a man with heat and inflammation of the
temporalis muscle and loss of sight [1]. In 1890, Hutchinson [2] described painful inflamed
temporal arteries that prevented a man from wearing his hat. Giant cell arteritis (GCA), which
was characterized as a distinct entity by Horton in 1932 [3], is now recognized as the most
common primary systemic vasculitis of the Western world in those aged over 50. The 2012
Revised Chapel Hill Consensus Conference (CHCC) Nomenclature [4] categorizes GCA as a
large vessel vasculitis (LVV); accordingly there may be subclinical aortic involvement [5, 6].

? Author Correspondence: John Kirwan, M.B., B.S., M.D., F.R.C.P., (UK), Academic Rheumatology Unit, Bristol
Royal Infirmary, Bristol BS2 8HW, UK. Email:[email protected]

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